Sodium vaiproate and biperiden in neuroleptic‐induced akathisia, parkinsonism and hyperkinesia

Abstract

ABSTRACT ‐ Fifteen psychiatric patients participated in a double‐blind cross‐over study of the effect of sodium valproate (a GABA mimetic drug), biperiden (an anticholinergic drug) and placebo in neuroleptic‐induced akathisia, parkinsonism and hyperkinetic movements. All patients had subjective and objective signs of akathisia, 11 had parkinsonism and 11 hyperkinesia, eight of which were tardive dyskinesia (TD) and three initial hyperkinesia. After a pretreatment washout period of 2 weeks, during which anticholinergic drugs, if any, were replaced by placebo, the patients were treated in three randomized periods of 4 weeks with sodium vaiproate, biperiden and placebo. Compared to placebo, sodium vaiproate (900–2400 mg/day, median 1700) had no significant effect on akathisia and parkinsonism, although akathisia was reduced in four patients (unchanged in 10 and increased in one) and parkinsonism was induced or aggravated in seven patients (unchanged in five and reduced in three). Sodium valproate, however, reduced hyperkinesia score (TD + initial hyperkinesia) from 1.6 to 1.2 ( P < 0.05). Biperiden (6–18 mg/day, median 12) significantly reduced akathisia score from 1.4 to 0.6 ( P < 0.01) and parkinsonism from 2.0 to 0.6 ( P < 0.01), and increased TD score from 2.1 to 3.9 ( P < 0.05). None of the drugs induced significant side effects. It is concluded that 1) sodium valproate has no significant effect on akathisia, but a slight beneficial effect in hyperkinetic movements, both TD and initial hyperkinesia, 2) sodium valproate may aggravate parkinsonism without necessarily aggravating akathisia, and 3) anticholinergic drugs like biperiden appear still to be the best treatment for akathisia.