Unprovoked Dystonic Reaction in a Child Taking Long-Term Methylphenidate

J Pharm Pract. 2022 Oct;35(5):796-799. doi: 10.1177/0897190021999781. Epub 2021 Apr 5.


In this report, we discuss the case of a 9-year-old male with Attention Deficit Hyperactivity Disorder (ADHD) on long-term methylphenidate and guanfacine who experienced acute orofacial dystonia that resolved immediately with the administration of benztropine. Current literature describes various cases of methylphenidate-induced dystonia, but ours appears to be the first reported instance of spontaneous dystonia without a recent change in dose or medication change. This may suggest the possibility of methylphenidate-induced dystonia spontaneously occurring several years after initiation.

Keywords: adverse drug reaction; dystonia; emergency medicine; methylphenidate.

Publication types

  • Case Reports

MeSH terms

  • Attention Deficit Disorder with Hyperactivity* / drug therapy
  • Benztropine / therapeutic use
  • Central Nervous System Stimulants* / adverse effects
  • Child
  • Dystonia* / chemically induced
  • Dystonia* / diagnosis
  • Guanfacine / pharmacology
  • Guanfacine / therapeutic use
  • Humans
  • Male
  • Methylphenidate* / adverse effects


  • Central Nervous System Stimulants
  • Benztropine
  • Methylphenidate
  • Guanfacine