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Adverse events of dopamine-blocking agents include acute dystonic reactions and oculogyric crises (OGCs). OGCs may be recurrent on maintenance of or re-exposure to the drug. Thus, complete withdrawal is recommended. Recurrent episodes of acute dystonia despite withdrawal and the lack of further exposure to antidopaminergic agents are usually not seen. Here, we report three cases with recurrent OGCs despite complete withdrawal of neuroleptics. Triggering or priming factors were a single dose of haloperidol in two cases and a single dose of metoclopramide in one case. Episodes reoccurred spontaneously, but responded to anticholinergics. The pathomechanisms of acute dystonic reactions and OGCs remain unclear. Parallels to levodopa-induced dyskinesias in Parkinson's disease, as well as to dopa-responsive dystonia, paroxysmal dyskinesias, and channelopathies are discussed here. Whether there is a genetic susceptibility or some other reason for only some patients developing this phenomenon remains unclear., ((c) 2009 Movement Disorder Society.)

Levodopa-induced ocular dyskinesias are very uncommon. Usually they occur simultaneously with limb peak-dose choreatic dyskinesias. We report on a patient with leftward and upward deviations of gaze during the peak effect of levodopa, and hypothesize that a severe dopaminergic denervation in the caudate nucleus is needed for the appearance of these levodopa-induce ocular dyskinesias., (Copyright 2001 Movement Disorder Society.)

Involuntary upward and lateral eye movements are described in two Parkinson's disease patients who also experience levodopa-induced choreoathetoid limb movements simultaneously. These brief deviations of gaze represent a rare ocular manifestation of dyskinesia and are similar to oculogyric movements resulting from other causes.

Six patients with chronically recurrent oculogyric crises (OGC) are reported. Four of these were derived from a study of 100 schizophrenic patients on maintenance neuroleptic medication, thereby giving a prevalence of 4% in such patients. Three of the six had the OGC develop as a tardive side-effect, and in one patient the episodes persisted for some months after the cessation of the offending neuroleptic drug. The episodes of ocular dystonia were associated with other dystonic movements and a number of psychiatric symptoms, with obsessional thoughts and hallucinations being the outstanding features in one patient each. This paper argues for an increased recognition of chronically recurrent and tardive OGC. It also draws attention to the fact that drug-induced OGC may be a multifaceted disorder with disturbances of movement, thought, behavior, and emotion, reminiscent of the OGC described in association with epidemic encephalitis lethargica.