Akineton (biperiden) / Endo, AbbVie - LARVOL DELTA

Levodopa exacerbated tremor in Parkinson's disease. (PubMed, Front Neurol) - "No benefit from biperiden or amantadine was observed for levodopa-exacerbated tremor in any of the cases. Patients with levodopa-exacerbated tremor were very reluctant to take more than a small dose of levodopa or any dose at all, hampering potential benefits for other parkinsonian features such as rigidity, bradykinesia, and parkinsonian gait. Tremor exacerbated by levodopa is an uncommon side effect in patients with PD that limits the benefit of this therapy."

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

Longitudinal neuropsychological safety assessment of biperiden treatment following traumatic brain injury. (PubMed, Exp Neurol) - "Biperiden showed no evidence of detrimental long-term neuropsychological effects following TBI. Cognitive outcomes were primarily determined by injury severity, lesion distribution, and cognitive reserve rather than pharmacological exposure, supporting its tolerability in acute post-TBI interventions targeting neuroplasticity modulation."

Journal • Alzheimer's Disease • CNS Disorders • Cognitive Disorders • Epilepsy • Vascular Neurology

Neurovascular and inflammatory effects of biperiden in the acute phase of moderate traumatic brain injury: evidence from a non-human primate model. (PubMed, Sci Rep) - "These findings provide preliminary evidence that repeated dosing with biperiden may modulate early neurovascular and glial responses and provide acute neuroprotection following moderate TBI in marmosets, mitigating neuronal injury, excitotoxicity, and inflammation. This work highlights biperiden as a promising therapeutic candidate for early intervention after TBI."

Journal • Preclinical • CNS Disorders • Inflammation • Vascular Neurology

Evaluation of long-term quality of life in traumatic brain injury patients early treated with biperiden - a randomized controlled trial. (PubMed, BMC Neurol) - P3 | "Biperiden did not impact QoL in TBI survivors. However, improvements were observed in the approximately 2 years following injury. Predictors like PTE, temporal lesions and receiving benefits as income were associated with lower Qol score. These preliminary findings guide future interventions for TBI patients and are particularly important as they fill a data gap for the Brazilian population."

Clinical • HEOR • Journal • CNS Disorders • Depression • Epilepsy • Psychiatry • Vascular Neurology

Coexistence of Parkinson's Disease and Myasthenia Gravis with Symptom Exacerbation Induced by Biperiden: A Case Report. (PubMed, Intern Med) - "Furthermore, the pharmacological treatments for these two disorders differ substantially, and medications used for one condition may exacerbate the other condition. We report a patient with PD complicated by MG, in whom anticholinergic treatment with biperiden led to the exacerbation of MG-related symptoms, ultimately resulting in the diagnosis of MG."

Journal • CNS Disorders • Fatigue • Gastrointestinal Disorder • Movement Disorders • Myasthenia Gravis • Parkinson's Disease

Risk of Akathisia with Antipsychotics and Its Treatment: Is Propranolol still the best option in 2025? (APA 2026) - " We performed a literature review using PubMed and PubMed Central databases using keywords in different combinations, like "akathisia and antipsychotics", "akathisia management", "akathisia and propranolol", "akathisia and ECT", "akathisia and benzodiazepines", "akathisia and mirtazapine", "akathisia and biperiden/anticholinergics", and "akathisia and vitamin B6" etc. We included data from thirty-nine observational, analytical, and review articles published in the last five years and summarized the key findings. Observations: Akathisia has been classically associated with first-generation high-potency antipsychotics like haloperidol. Among atypical antipsychotics Risperidone (mean dose of 5.4mg/day) and Lurasidone (mean dose of 240mg/day), Cariprazine and Ziprasidone have been found causing akathisia at higher therapeutic dosages, while the risk is found to be lower with Sertindole..."

CNS Disorders

Neurologic Presentations of Pediatric Intussusception Lead to Diagnostic Delay and Increased Need for Surgery. (PubMed, Am Surg) - "He was initially misdiagnosed with tardive dyskinesia and treated with biperiden without improvement...Critically, patients with neurological presentations required surgical intervention in 60% of cases compared with 18% of classic presentations (P < 0.001), with approximately one-quarter of surgical patients requiring bowel resection, reflecting more advanced disease at diagnosis.ConclusionIntussusception should be considered in infants and young children with unexplained acute neurological symptoms, particularly when initial neurologic evaluation is unrevealing. Early abdominal imaging may prevent diagnostic delay in this reversible surgical emergency."

Journal • Review • Movement Disorders • Pediatrics

Acute Drug-Induced Dystonia in Children: Risk Factors, Clinical Characteristics, and Emergency Management. (PubMed, Pediatr Emerg Care) - "Antipsychotics and antiemetics are the main triggers of drug-induced acute dystonia in children. Dystonia usually appears within the first 72 hours after starting the drug. It can develop even at therapeutic doses. Dystonias associated with antiemetic drugs often show focal or segmental distribution. Parenteral biperiden is a fast and effective treatment option. Acute dystonia can mimic serious etiologies in the emergency department. Obtaining a detailed drug history can facilitate the diagnostic process."

Journal • CNS Disorders • Dystonia • Movement Disorders • Pediatrics • Psychiatry

Antonio Austregesilo: Founder Father of Brazilian Neurology and a Pioneer in Movement Disorder Research (AAN 2026) - "In 1928, he published the first documented case of post-traumatic dystonia, anticipating the modern classification of organic dystonias.?In 1945, he advocated the use of atropine and scopolamine to relieve rigidity and tremor in Parkinsonian patients...Modern antiparkinsonian therapy still employs central anticholinergic agents such as trihexyphenidyl and biperiden, following the same physiological rationale Austregesilo first proposed, decades before dopamine’s role in motor control was elucidated. Conclusions Austregesilo’s clinical reasoning anticipated modern neurochemical models of basal ganglia pathways. His work allowed an intersection between classical neurological semiology and emerging neurophysiology concepts, with a major contribution to what was established as the intellectual and institutional foundations of Brazilian neurology and movement disorder research."

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

REVERSAL OF BIPERIDEN-INDUCED COGNITIVE IMPAIRMENT BY DONEPEZIL: A PROOF-OF-PHARMACOLOGY TOOL FOR MUSCARINIC MODULATORS IN HEALTHY ELDERLY (ADPD 2026) - "The model demonstrated low and acceptable intersubject (∼30–35%) and intrasubject (∼18–24%) variability in plasma Cmax and AUC0–last, further supporting its reliability for repeated-measures study designs. These findings validate the 2.6 mg IV biperiden challenge model as a robust tool for proof-of-pharmacology studies of novel mAChR modulators in early-stage clinical development."

Clinical • Alzheimer's Disease • CNS Disorders • Cognitive Disorders

Consensus Molecules Associated with Parkinson's Disease. (PubMed, Neurol Int) - "Drugs include L-dopa (49%), carbidopa (63%), benserazide (50%), entacapone (74%), tolcapone (56%), rasagiline (76%), selegiline (46%), pargyline (4%), ropinirole (61%), pramipexole (56%), lisuride (27%), cabergoline (16%), bromocriptine (12%), and zonisamide (9%). Adjunctive therapies include droxidopa (33%), trihexyphenidyl (28%), biperiden (17%), amantadine (24%), memantine (7%), rivastigmine (13%), donepezil (6%), galantamine (4%), domperidone (6%), clonazepam (4%), tetrabenazine (16%), mazindol (13%), quetiapine (6%), and clozapine (4%). Contraindicated drugs include haloperidol (4%), sulpiride (3%), and methyldopa (6%)...Chemical inducers of PD include 6-hydroxydopamine (40%), N-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP, 78%), tetrahydropyridine (77%), probenecid (4%), quinolinic acid (4%), 1,2,3,4-tetrahydroisoquinoline (TIQ, 16%), salsolinol (32%), rotenone (25%), and β-Methylamino-L-alanine (BMAA, 29%). Notably, our study highlights conditional essential..."

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

Copy-number loss of 17p11.2 with a TMEM127 pathogenic variant: a unique case of combined Smith-Magenis, Birt-Hogg-Dubé, and Hereditary Paraganglioma-Pheochromocytoma syndromes. (ACMG 2026) - "Treatment and Management Current medications are metformin, losartan, simvastatin, risperidone, haloperidol, and biperiden, as well as continuous CPAP therapy. Conclusion We report a patient carrying a likely de novo 17p11.2 microdeletion involving RAI1 , FLCN , and TNFRSF13B , together with a pathogenic heterozygous TMEM127 variant, resulting in combined features of Smith-Magenis, Birt-Hogg-Dubé, and Hereditary Paraganglioma-Pheochromocytoma syndromes. This case underscores the need for an integrated genotype-phenotype interpretation and a coordinated clinical approach through multidisciplinary management for the adequate care and counselling of patients with multiloci genetic conditions."

Clinical • CNS Disorders • Developmental Disorders • Diabetes • Dyslipidemia • Genetic Disorders • Hypertension • Infectious Disease • Kidney Cancer • Mental Retardation • Metabolic Disorders • Neuroendocrine Tumor • Obesity • Obstructive Sleep Apnea • Otorhinolaryngology • Renal Cell Carcinoma • Respiratory Diseases • Sleep Disorder • Solid Tumor • Type 2 Diabetes Mellitus • FLCN • RAI1 • TMEM127 • TNFRSF13B

Chronic effects of traumatic brain injury and the impact of biperiden treatment in a male rat model. (PubMed, Exp Neurol) - "Biperiden enhanced vascular remodeling and partially mitigated long-term histopathological changes after TBI, though its protective effects on cognitive and seizure-susceptibility responses were limited. These findings highlight biperiden's potential to influence vascular and inflammatory responses in the injured brain."

Journal • Preclinical • Alzheimer's Disease • CNS Disorders • Epilepsy • Inflammation • Vascular Neurology • CA3 • NEFL • Plasma NfL

Effects of acute biperiden treatment following traumatic brain injury in male rats. (PubMed, Sci Rep) - "Additionally, biperiden preserves microglial branching following injury. These findings demonstrate that biperiden exerts beneficial effects during the acute phase of TBI by decreasing neuronal degeneration, excitotoxicity, and inflammation, highlighting its therapeutic potential for post-TBI intervention."

Journal • Preclinical • CNS Disorders • Inflammation • Vascular Neurology

Biomarkers. (PubMed, Alzheimers Dement) - P3 | "Our findings underscore the feasibility of serum biomarkers such as GFAP and NfL to bridge the understanding of the molecular link between TBI and AD. The SIMOA technology enables precise quantification of biomarkers, providing valuable knowledge into the time window from the moment of TBI to the development of AD, allowing for the analysis of long-term neurodegeneration. These results reinforces the importance of personalized approaches to diagnosis and therapeutic monitoring."

Biomarker • Clinical • Journal • Alzheimer's Disease • CNS Disorders • Vascular Neurology • GFAP • UCHL1

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