RISPERIDONE AND INCREASED INTRACRANIAL PRESSURE-LIKE SYNDROME IN CHILDREN AND ADOLESCENTS

Objectives: Headache is a relatively common adverse effect of risperidone. In this study we investigated the clinical spectrum of headaches in children and adolescents treated with risperidone.

Methods: Our investigation included clinical evaluation, and when necessary, brain imaging and lumbar puncture (LP).

Results: Six patients (5 males, 1 female) developed significant headaches while treated with risperidone. The clinical diagnoses that led to treatment were autistic spectrum disorders associated with agitation (2 patients) and disruptive or aggressive behavior (4 patients). Four patients suffered moderate headaches which were tolerable. Two patients developed severe intolerable and progressive headaches (primarily morning headaches) associated with somnolence and vomiting. There was no papilledema but the clinical picture was severe enough to raise the possibility of increased intracranial pressure (ICP). One of these patients was diagnosed a few years earlier as having multiple cerebral cavernous hemangiomas. Repeated magnetic resonance imaging after onset of headaches showed no change and ruled out intracranial hemorrhage or other findings consistent with increased ICP. Head computerized tomography (CT) of the other patient was normal except for mild corpus callosum hypoplasia. Both patients underwent LP which revealed normal opening pressure and normal cerebral spinal fluid analysis. Cessation of therapy led to rapid recovery and resolution of the headaches.

Conclusion: These preliminary findings suggest that risperidone induced headaches may mimic a clinical picture of increased ICP. The enzyme CYP2D6 metabolizes risperidone. Since a higher incidence of adverse effects was reported in patients with CYP2D6-deficiency, one cannot rule out the possibility that this enzymatic deficiency might lead to increased-ICP like syndrome in these patients. Further studies are required to better elucidate this phenomenon.