Akineton (biperiden) / Endo, AbbVie - LARVOL DELTA

Effects of biperiden (cholinergic muscarinic m1/m4 receptor antagonist) on craving nicotine: a proof-of-concept clinical study. (PubMed, Eur Addict Res) - "Further studies with prolonged administration are warranted to evaluate its therapeutic potential for smoking cessation. Registration Number: ensaiosclinicos.gov.br/ Identifier RBR-7qtvbh3."

Journal • CNS Disorders • Depression • Mood Disorders • Psychiatry • Tobacco Cessation

BIPERIDEN Trial: Early Observations of a Randomized, Double-Blind, Placebo-Controlled Study on the Prevention of Post-Traumatic Epilepsy (AES 2025) - P3 | "The BIPERIDEN trial is advancing as an important multicenter randomized clinical study designed to evaluate an antiepileptogenic intervention in TBI. Recruitment and longitudinal follow-up have demonstrated feasibility of the protocol, with timely initiation of treatment and satisfactory adherence, despite the challenges of emergency care. Early descriptive data confirms the expected severity profile of enrolled patients and the observed incidence of PTE."

Clinical • Late-breaking abstract • CNS Disorders • Epilepsy • Vascular Neurology

Comparison of Clinical Outcomes in Adolescents With Psychotic Symptoms Diagnosed With Bipolar Disorder and Schizophrenia (AACAP 2025) - "The most prescribed medications for BAD were aripiprazole (81.6%), quetiapine (65.8%), and lorazepam (65.8%), while for schizophrenia, they were lorazepam (41.7%), biperiden (41.7%), and paliperidone (37.5%). Although some differences were observed between the 2 groups—such as a higher prevalence of intellectual disability in patients with schizophrenia and variations in prescribed medications—most comparisons, including the number of hospitalizations and family history of mental disorders, did not reach statistical significance.SZ, APS, PSY"

Clinical • Clinical data • Bipolar Disorder • CNS Disorders • Depression • Developmental Disorders • Mental Retardation • Mood Disorders • Psychiatry • Schizophrenia

Dystonic lower limb tremor secondary to involvement of the substantia nigra in a patient with Neurotoxoplasmosis and HIV (MDS Congress 2025) - "Neuroinfectious disorders are highly prevalent in limited resource settings, like in our country, leading to morbidy and mortality. Prompt recognizing the clinical manifestation of these disorders is necessary for improving care of this patients, where levodopa and biperiden were prescribed with excellent clinical response. Figure 1 Figure 2"

Clinical • CNS Disorders • Dystonia • Movement Disorders • CD4

In psychiatry, not all that trembles is parkinsonism: Wilson's disease as differential diagnosis for extrapyramidal symptoms in a young adult (ECNP 2025) - "Over the previous two years, he had been hospitalized twice for psychotic episodes following polysubstance use (cannabis, ketamine, MDMA)...At the time of his current presentation, he was being treated with high-dose haloperidol and biperiden...Pharmacological treatment with clozapine and lorazepam was therefore initiated, resulting in only partial improvement of motor symptoms... As the scope of psychiatry continues to expand and knowledge of autoimmune, metabolic, and genetic conditions advances, psychiatrists are increasingly required to recognize, beyond the psychiatric phenotype, clinical presentations driven by organic etiologies. Early suspicion, appropriate diagnostic work-up, and interdisciplinary collaboration are essential o avoid diagnostic delays and adverse outcomes for the patients. Though uncommon, Wilson's Disease should be considered in the differential diagnosis of early-onset extrapyramidal and behavioral symptoms, especially when symptoms worsen..."

Clinical • CNS Disorders • Dystonia • Movement Disorders • Parkinson's Disease • Psychiatry • ATP7B

Efficacy and tolerability of adjunctive lamotrigine in schizophrenia: A case report (ECNP 2025) - "Aripiprazole was discontinued due to lack of efficacy, risperidone due to the development of hyperprolactinaemia, and clozapine due to significant weight gain and concerns regarding obesity...Adjunctive therapy with lamotrigine was initiated following recommended guidelines, slowly titrated from 25 mg/day to 200 mg/day over several weeks, alongside ongoing treatment with haloperidol (20 mg/day), biperiden (5 mg/day), diazepam (5–10 mg/day), and fluoxetine (20 mg/day)... This case supports the potential therapeutic role of adjunctive lamotrigine in schizophrenia patients exhibiting persistent emotional dysregulation and irritability despite standard antipsychotic treatments [3,4]. The normalization of EEG findings correlating with clinical improvements further suggests possible beneficial neurophysiological effects of lamotrigine. Nevertheless, larger-scale studies and randomized controlled trials are necessary to substantiate these preliminary findings, elucidate the..."

Case report • Clinical • CNS Disorders • Cognitive Disorders • Mental Retardation • Psychiatry • Schizophrenia

A case of neuroleptic malignant syndrome following antipsychotic use in unrecognised catatonia: recognising Catatonia prior to antipsychotic exposure (ECNP 2025) - "He was treated at the emergency service with daily intramuscular haloperidol 5 mg and biperiden 5 mg for six consecutive days...Although lorazepam is the first-line agent for catatonia, it was unavailable; thus, alprazolam 0.5 mg three times daily was initiated. Adjunctive treatments included bromocriptine (4x1/2) and amantadine sulphate (100 mg once daily), which was later increased to twice daily...Quetiapine 100 mg/day was introduced, and alprazolam was increased to 1 mg four times daily...Given the persistence of psychotic symptoms and the elevated risk of recurrence with other antipsychotics, clozapine was selected as the safest option in this context [4]...In catatonic patients, benzodiazepines and/or ECT should be prioritised, and antipsychotics must be used with extreme caution only after clinical improvement has been achieved [2,4]. The literature highlights the diagnostic overlap between catatonia and NMS and emphasises that failure to identify catatonia may..."

Clinical • CNS Disorders • Psychiatry • Schizophrenia • CRP

The effect of clozapine on negative symptoms in treatment-resistant schizophrenia (ECNP 2025) - "Risperidone was initiated at 1 mg/day and gradually increased to 6 mg/day...Upon starting clozapine, quetiapine was discontinued, and biperiden 6 mg/day was added...Studies suggest that the impact of clozapine on negative symptoms is independent of its effects on positive and depressive symptoms (3). Clozapine plays a unique role in the treatment of negative symptoms."

CNS Disorders • Psychiatry • Schizophrenia

Anti-N-Methyl-D-Aspartate receptor encephalitis presenting with catatonia: A case report (ECNP 2025) - "IVIG therapy is ongoing, and symptomatic management with alprazolam and biperiden is being concurrently administered...This may not only fail to improve symptoms but also worsen the clinical picture, as illustrated in our patient who developed neuroleptic malignant syndrome after haloperidol. While benzodiazepines remain the first-line symptomatic treatment for catatonia, treating the underlying pathology is essential in cases secondary to medical conditions [5]. Our patient exhibited minimal response to a lorazepam challenge test but showed a significant clinical improvement following IVIG therapy, underscoring the need for immunomodulatory treatment in anti-NMDAR encephalitis."

Case report • Clinical • Alzheimer's Disease • CNS Disorders • Cognitive Disorders • Dementia • Epilepsy • Frontotemporal Lobar Degeneration • Mental Retardation • Mood Disorders • Movement Disorders • Psychiatry • Psychomotor Agitation

COVID-19-Related psychosis and 3-year follow-up: A case report (ECNP 2025) - "During hospitalization, she was treated with intramuscular haloperidol and biperiden, followed by paliperidone palmitate...Due to persistent anhedonia and lack of motivation, sertraline 50 mg/day was added, resulting in full remission...Despite experiencing recurrent episodes, the patient achieved full remission and significant functional recovery. Her complete symptom resolution and reintegration into academic life underscore the importance of future studies to better understand the psychiatric impacts of the pandemic."

Case report • Clinical • CNS Disorders • Mental Retardation • Psychiatry

Psychosis or thyrotoxicosis? A rare endocrine mimicry in a woman with no psychiatric history: a case report (ECNP 2025) - "She was provisionally diagnosed with non-organic psychosis and treated with haloperidol 20 mg/day and biperiden 5 mg/day...The patient was started on propylthiouracil (200 mg/day), prednisolone (32 mg/day for three days), propranolol (60 mg/day), and pantoprazole (40 mg/day)...In cases of atypical, acute psychotic exacerbation with suboptimal response to antipsychotics, clinicians must maintain a high index of suspicion for underlying organic etiologies. Timely endocrinological assessment and multidisciplinary management can facilitate rapid remission, minimize unnecessary psychiatric pharmacotherapy, and prevent prolonged misdiagnosis."

Case report • Clinical • CNS Disorders • Mental Retardation • Psychiatry • Schizophrenia

Challenges in the management of untreated chronic psychosis: a case report (ECNP 2025) - "Initial treatment included fluphenazine as the main antipsychotic, along with clozapine, biperiden, and nitrazepam. Lorazepam was later added to manage anxiety. As therapy progressed, the fluphenazine dose was reduced, and amitriptyline was introduced to address residual and negative symptoms...Her prolonged hospitalization and slow progress reflect the complex challenges associated with treating psychosis that has remained untreated for many years. This case also highlights how psychiatric illness can go unrecognized or untreated in families for extended periods, sometimes resulting in multi-generational patterns of dysfunction and avoidance of care."

Case report • Clinical • CNS Disorders • Mental Retardation • Mood Disorders • Psychiatry • Schizophrenia

Tardive dyskinesia after biperiden in a bipolar patient: a case report (ECNP 2025) - "This case report suggests that biperiden may contribute to the development or exacerbation of TD in patients treated for antipsychotic-induced EPS. While anticholinergic agents are commonly used to manage parkinsonism in psychiatric patients, clinicians should be cautious about their potential to induce new-onset movement disorders such as oromandibular dyskinesia. Careful monitoring is essential, and drug withdrawal should be considered when new movement symptoms occur."

Case report • Clinical • Bipolar Disorder • CNS Disorders • Movement Disorders • Parkinson's Disease • Psychiatry

Dissociative amnesia and brief psychotic disorder comorbidity: a long-term clinical follow-up case analysis (ECNP 2025) - "Initial treatment involved intramuscular haloperidol (10 mg/day) and biperiden (4 mg/day) for four days...Maintenance treatment included oral risperidone (6 mg/day), monthly intramuscular risperidone (Risperdal Consta 25 mg), lamotrigine (up to 400 mg/day), sertraline (100 mg/day), and lithium (1200 mg/day)...A holistic, continuous approach addressing biological, psychological, and social factors is essential to improve functioning and prevent chronic disability. Keywords: dissociative amnesia; brief psychotic disorder; psychosocial stressors; electroconvulsive therapy (ECT); long-term follow-up"

Clinical • Bipolar Disorder • CNS Disorders • Cognitive Disorders • Depression • Mood Disorders • Psychiatry

Pharmacological management of antipsychotic-induced blepharospasm in a patient with schizophrenia: A case report and literature review (ECNP 2025) - "In response, risperidone was discontinued and replaced with aripiprazole, which was gradually titrated up to 20 mg/day...In such cases, adjunctive oral agents such as anticholinergics (e.g., biperiden) can provide additional symptomatic relief and improve patient outcomes... Although antipsychotic-induced blepharospasm is rare with atypical agents, it should be recognised as a potential complication in patients receiving long-term antipsychotic therapy. When modification of antipsychotic treatment is limited by psychiatric risk, combining BoNT with oral anticholinergic medication can provide significant symptomatic relief. This case underscores the importance of a multidisciplinary approach, ongoing monitoring for movement disorders, and the development of individualised treatment plans for patients with severe mental illness who require sustained antipsychotic therapy."

Case report • Clinical • Review • CNS Disorders • Dystonia • Movement Disorders • Psychiatry • Schizophrenia

An MPAN case initially presenting with psychiatric manifestations (ECNP 2025) - "At the time of admission, her medications included buspirone (15 mg/day), valproic acid (1500 mg/day), and propranolol (40 mg/day)...Intramuscular biperiden was administered, followed by oral biperiden. Olanzapine was discontinued and quetiapine XR (450 mg/day) was prescribed instead...Informed consent was obtained. No conflicts of interest were declared."

Clinical • CNS Disorders • Depression • Dystonia • Mental Retardation • Mood Disorders • Movement Disorders • Parkinson's Disease • Psychiatry • FTL

Use of unconventional adjunctive therapies in a treatment-refractory psychiatric syndrome (ECNP 2025) - "She showed unexpected worsening of symptoms and side effects to several antipsychotics, including extrapyramidal symptoms with low-dose olanzapine and aripiprazole, and significant hyperprolactinemia with low doses of haloperidol. The patient was initiated on clozapine, valproic acid, biperiden, and diazepam, with subsequent additions of lithium carbonate and low-dose cariprazine... In complex, treatment-refractory psychiatric cases, adjunctive therapies should be considered. N-acetylcysteine may modulate glutamatergic transmission and restore glutathione-dependent antioxidant defense [2]. Omega-3 fatty acids could improve neuronal membrane fluidity and modulate systemic inflammation [3], and folate supplementation is supposed to support monoamine synthesis and methylation pathways in the CNS [4]."

CNS Disorders • Mood Disorders • Obsessive-Compulsive Disorder • Psychiatry • Psychomotor Agitation

Combined use of risperidone and cariprazine in treatment-resistant schizophrenia with prominent negative symptoms: case report (ECNP 2025) - "The final treatment regimen included risperidone (3 mg in the morning, 4 mg in the evening) and cariprazine (3 mg daily), along with adjunctive therapy comprising biperiden (2 mg twice daily) and clonazepam (0.5 mg in the morning, 1 mg in the evening). The findings from this case support the potential therapeutic benefit and tolerability of combining risperidone, a dopamine D2 antagonist, with cariprazine, a dopamine D3/D2 partial agonist, in managing treatment-resistant schizophrenia characterized by predominant negative symptoms. This case highlights the promising pharmacological synergy that can address both positive and negative symptom domains simultaneously. Nevertheless, these findings warrant further investigation through controlled clinical trials to conclusively establish efficacy, safety, and long-term outcomes associated with this novel therapeutic approach."

Case report • Clinical • CNS Disorders • Psychiatry • Schizophrenia

Early-onset tardive akathisia following long-acting aripiprazole treatment: successful management with mirtazapine (ECNP 2025) - "Our patient achieved near-full remission of akathisia only after mirtazapine was increased to 30 mg/day,following nonresponse to propranolol, biperiden, clonazepam, and hydroxyzine. Given the 2.5-month gap since the last injection, the remission may be partly due to LAI cessation rather than solely to mirtazapine, although spontaneous remission of tardive akathisia is rare.Although prior studies support the effectiveness of low-dose mirtazapine (15 mg/day) in treating antipsychotic-induced akathisia, our case suggests that higher doses may be required in tardive or refractory presentations[4].Moreover, our case contributes to the limited but growing literature implicating LAI aripiprazole in severe akathisia, even among patients who previously tolerated the oral form[5]. These findings underscore the importance of recognizing early-onset tardive akathisia and considering mirtazapine dose escalation as a second-line strategy when conventional treatments fail."

CNS Disorders • Movement Disorders • Psychiatry

A challenging case of anti-GABA-B receptor encephalitis (ECNP 2025) - " Initial treatment included IM haloperidol, oral valproate, biperiden, and benzodiazepines. Clinicians should maintain a high index of suspicion for autoimmune encephalitis in TRP cases with sudden cognitive decline, atypical features, or paradoxical responses to clozapine. Anti-GABA-B receptor encephalitis, though rare, is a potentially reversible cause of severe psychiatric symptoms. Timely immunotherapy can dramatically alter prognosis."

Clinical • IO biomarker • CNS Disorders • Psychiatry • CRP

Management of severe irritability and inappropriate sexual behavior in an adolescent with autism spectrum disorder: Clinical response to amisulpride (ECNP 2025) - "Risperidone and aripiprazole are FDA-approved medications for ASD-related irritability, but adverse effects (e.g., weight gain, sedation) may limit their use [3].Amisulpride, a D2/D3 dopamine antagonist, is rarely used in ASD but has a favorable side effect profile and theoretical benefits in controlling behavioral disinhibition...These behaviors persisted despite structured behavioral therapies.At an external center, he was prescribed risperidone 0.5 mg/day and methylphenidate 20 mg/day, followed by the addition of sertraline 50 mg/day...Cranial MRI and EEG were also normal.Initial treatment with quetiapine 25–75 mg/day was ineffective and stopped. After the patient experienced jaw stiffness following an intramuscular injection, biperiden 6 mg/day was added...The goal should always be to support self-regulation, not suppress sexuality. This case supports the cautious use of amisulpride in refractory cases, but controlled studies are needed to validate its role in ASD.."

Clinical • CNS Disorders • Mental Retardation

Postoperative psychosis after temporal lobectomy: A case report (ECNP 2025) - "She was prescribed sertraline 50 mg/day; however, she discontinued the medication after three days due to flu-like symptoms and nausea...The patient was initiated on risperidone 4 mg/day and biperiden 2 mg/day...These findings underscore the need for a multidisciplinary approach in the management of patients undergoing epilepsy surgery. Comprehensive preoperative psychiatric evaluation, including assessment of psychiatric history, personality traits, and psychosocial stressors, is essential to anticipate and manage potential neuropsychiatric outcomes in the postoperative period."

Case report • Clinical • CNS Disorders • Depression • Epilepsy • Insomnia • Psychiatry • Sleep Disorder

CASE PRESENTER 2: LIMITED-RESOURCE SETTINGS AND A COMPLEX PSYCHIATRIC CASE: PSYCHOTIC BIPOLAR DEPRESSION WITH CATATONIA (WPA-WCP 2025) - "These included lamotrigine, quetiapine, alprazolam, biperiden, lorazepam (up to 12mg/day), fluoxetine, olanzapine, amantadine, aripiprazole, and clozapine. This case highlights the complexity of managing catatonia when significant psychotic symptoms are present, weighing the benefits and risks of psychoactive drugs. Additionally, a late brain magnetic resonance image showed an arachnoid cyst and microangiopathy, findings that could or not be involved in the patient's clinical presentation."

Clinical • Bipolar Disorder • CNS Disorders • Depression • Insomnia • Mood Disorders • Psychiatry • Sleep Disorder

Parkinson disease treatments on national essential medicines lists, African Region. (PubMed, Bull World Health Organ) - "Overall, of any formulation or strength, 81% (38/47) of countries included levodopa + carbidopa or levodopa + benserazide as a therapeutic alternative on their national lists; and 79% (37/47) included biperiden or trihexyphenidyl as a therapeutic alternative. While inclusion of medicines for Parkinson disease in national essential medicines lists provides no guarantee of immediate access, it can encourage procurement, prescribing and use, and can help lower costs, raise awareness of and create political will for Parkinson disease treatment. This analysis provides further evidence of the need for action to improve the accessibility of medicines for Parkinson disease in the WHO African Region."

Journal • CNS Disorders • Movement Disorders • Parkinson's Disease

Drug reaction with eosinophilia and systemic symptoms triggered bycarbamazepine : Cross-reactivity to lamotrigine confirmed by rechallenge (EADV 2025) - "The frequency of cross- reactivity among anticonvulsants (carbamazepine, phenytoin, phenobarbital, and primidone) is as high as 40%—80% among aromatic AEDs explained by their common aromatic ring. Nevertheless, cross- reactivity between aromatic and non-aromatic AEDs (valproic acid, lamotrigine, and levetiracetam.) is less commonly reported...With a score of 7 points, DRESS syndrome is considered to be « definite », according to the RegiSCAR group and CMZ, risperidone and biperiden were withdrawn... According to the Naranjo Causality Scale, the accountability of both drugs was found to be probable (score of '6'). Through this report, we add to the medical literature a new case of DRESS syndrome induced by CMZ, cross-reacting to lamotrigine, anon aromatic AED. This was confirmed by a positive rechallenge to lamotrigine, with a negative result on PT."

Bipolar Disorder • CNS Disorders • Eosinophilia • Hepatology • Infectious Disease • Inflammation • Mood Disorders • Pruritus • Psychiatry