A Chinese American woman with a history of bipolar disorder presented with extrapyramidal symptoms (EPS) after re-initiating lithium carbonate following a manic episode. Despite previous tolerance to lithium, she developed neurological symptoms, including stiffness and restlessness, shortly after restarting the medication. The patient was not compliant with her medications, and her lithium levels were subtherapeutic.
Lithium, a well-established mood stabilizer for bipolar disorder, can cause rare but significant EPS, including cogwheel rigidity, stiffness, and tremors. The exact mechanism is unclear, but selective dopamine blockade has been suggested. In this case, the patient’s EPS did not respond to benztropine and resolved only after discontinuing lithium. This case underscores the need for clinicians to consider lithium as a potential cause of EPS and the importance of monitoring and managing these side effects, especially since they can occur with recent initiation and subtherapeutic levels. Further research is needed to better understand lithium-induced EPS and effective management strategies.
Reference: Orji GI, Mansoor M, Bellegarde SB, et al. Extrapyramidal Symptoms in a Bipolar 1 Patient Following Re-initiation of Lithium: A Case Report. Cureus. 2023 May 22;15(5):e39361. doi: 10.7759/cureus.39361. PMID: 37362457; PMCID: PMC10285111.
