Vitamin E Shows Promise for Treating Antipsychotic-Induced Movement Disorders: A Case Report

The case concerns a 28-year-old man with a psychotic disorder who developed severe EPS and TD after receiving paliperidone injections. Symptoms included muscle rigidity, parkinsonian gait, and pronounced involuntary motor disturbances. Despite discontinuing paliperidone and trying multiple conventional treatments—including procyclidine, propranolol, clonazepam, and omega-3 supplements—his symptoms persisted.

A novel approach was adopted with the introduction of oral vitamin E at a dose of 400 IU daily. The patient showed a remarkable 80% reduction in symptoms within weeks. His Abnormal Involuntary Movement Scale (AIMS) score, a tool used to assess TD severity, dropped from 24 to 4. Encouraged by these results, clinicians gradually increased the vitamin E dosage to 1200 IU daily while tapering other medications. Ultimately, the patient experienced a complete resolution of symptoms, with his AIMS score reaching 0 and no recurrence of psychotic episodes.

This case by Syed Ali Bokhari, Psychiatry, Al Amal Psychiatric Hospital, Emirates Health Services, Dubai, ARE, and colleagues highlights vitamin E’s potential as an effective treatment for TD and EPS, particularly in patients unresponsive to standard therapies. The antioxidant properties of vitamin E are thought to combat oxidative stress, which plays a role in TD’s pathophysiology. Although research on vitamin E’s efficacy in treating TD has been mixed, this report contributes to growing evidence supporting its benefits, especially when initiated early.

The patient’s recovery underscores the importance of exploring alternative treatments for antipsychotic-induced side effects. It also emphasizes the need for larger clinical trials to determine optimal dosing and identify patients most likely to benefit from vitamin E therapy.

For individuals affected by antipsychotic-induced TD, vitamin E may represent a hopeful step toward improved management of this challenging condition, offering not only symptom relief but also a chance at a better quality of life.

"Although existing literature offers mixed evidence on the effectiveness of vitamin E, this case contributes to the expanding research indicating its potential benefits, particularly when administered early in the disease. Larger-scale studies are needed to determine optimal treatment protocols and identify the patient groups most likely to respond favorably to vitamin E therapy," the researchers concluded.

Reference:

Elnoor M, Bokhari S, Singh M, et al. (August 30, 2024) Effectiveness of Vitamin E in Treatment of Antipsychotic-Induced Tardive Dyskinesia and Extrapyramidal Symptoms: A Case Report. Cureus 16(8): e68231. doi:10.7759/cureus.68231