Extrapyramidal Symptoms: Tremors, Hair Pulling, and Communication Issues

Extrapyramidal syndrome

Is leg shaking also a symptom of extrapyramidal syndrome? Additionally, is the constant pulling of hair (especially nasal hair) considered a symptom of extrapyramidal syndrome? So, are leg shaking and hair pulling both symptoms of extrapyramidal syndrome? Furthermore, if someone can communicate normally in person but has difficulty speaking clearly over the phone, should they consult a psychiatrist or an otolaryngologist for better evaluation?

Li Wei, 30~39 year old female. Ask Date: 2023/01/22

Dr. Wu Kunhong reply Psychiatry

There are many reasons why people may shake their legs, and one possible cause is extrapyramidal syndrome.
Initial assessments such as hair pulling and unclear speech should be conducted, and then a physician can advise whether a referral to an otolaryngologist or psychiatrist is necessary, as there are various potential causes related to both physical and mental health.
It is recommended that you first seek a preliminary evaluation at a family medicine or neurology clinic, and if needed, you can be referred to a mental health (psychiatry) or otolaryngology specialist for further treatment.
If the situation is urgent, you may also go to the emergency department.
Wishing you well and safe.
Dr.
Wu Kun-Hong

Reply Date: 2023/01/22

More Info

Extrapyramidal symptoms (EPS) are a group of side effects that can occur with certain medications, particularly antipsychotics. These symptoms are related to the extrapyramidal system, which is involved in the coordination of movement. Common EPS include tremors, rigidity, bradykinesia (slowness of movement), and akathisia (a feeling of inner restlessness).
To address your specific questions:
1. Tremors and Foot Tapping: Yes, tremors can be a symptom of extrapyramidal syndrome. They often manifest as rhythmic shaking of the hands or other body parts. Foot tapping, while not a classic tremor, can be considered a form of akathisia, where an individual feels an uncontrollable urge to be in constant motion. This can include repetitive movements such as tapping feet or shifting in one's seat. If you find yourself tapping your foot frequently and feel restless, it may be related to EPS.

2. Hair Pulling: The act of pulling out hair, known as trichotillomania, is not typically classified as an extrapyramidal symptom. Instead, it is considered a mental health disorder often associated with anxiety or stress. While it can occur alongside other conditions, including those that cause EPS, it is not a direct symptom of extrapyramidal syndrome itself. If you are experiencing compulsive hair pulling, it may be beneficial to consult a mental health professional who can help address underlying issues.

3. Communication Issues: Regarding your difficulty in communicating, especially over the phone, it is essential to consider the context of your symptoms. If you can communicate well in person but struggle with phone conversations, this could be related to anxiety or a specific communication disorder. It may be beneficial to consult a mental health professional, such as a psychiatrist or psychologist, who can evaluate your symptoms in the context of your overall mental health. If there are concerns about hearing or auditory processing, then an evaluation by an ear, nose, and throat (ENT) specialist or an audiologist may be appropriate.

In summary, while tremors and foot tapping can be related to extrapyramidal symptoms, hair pulling is not typically classified as such. Communication difficulties may require a multidisciplinary approach, involving both mental health professionals and possibly ENT specialists, depending on the nature of the symptoms. It is essential to discuss these symptoms with your healthcare provider to determine the best course of action and to explore any underlying conditions that may be contributing to your experiences.

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