The extrapyramidal symptoms rating scale (ESRS) and its use in the evaluation of risperidone

Extrapyramidal symptoms (EPS) associated with neuroleptic drug treatment include dystonia, parkinsonism, and dyskinetic movements. They are thought to be due to blockade of dopamine-D-2 receptors in the basal ganglia, and may occur in 75-90% of patients treated with conventional neuroleptics. Systematic and reliable assessment of drug-induced movement disorders is essential, since EPS can be harmful and very distressing to the patient, often also leading to non-compliance. Several scales for rating EPS have been developed, of which the Extrapyramidal Symptoms Rating Scale (ESRS) is the most complete. The ESRS was used in multicentre trials of the serotonin-dopamine antagonist risperidone, which demonstrated consistency between the results from the ESRS and the use of antiparkinsonian medication. Together with its efficacy against the positive, negative, and affective symptoms of schizophrenia, and low incidence of EPS with standard doses, compared to conventional neuroleptics, risperidone may represent a major step forward in the care of patients with schizophrenia.