You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
metoclopramide is a benzamide selective dopamine d2 receptor antagonist that is used as an antiemetic , with side effects that are seen frequently in children.1 the commonest and most important side effects of metoclopramide are acute extrapyramidal symptoms , which require immediate treatment.2,3 acute dystonic reactions occur as contractions of the muscles , opisthotonus , torticollis , dysarthria , trismus , and oculogyric crisis.4 although the incidence of metoclopramide - induced acute dystonic reactions has been reported to be 25% in children , there are few published cases on oculogyric crisis in general.5,6 we report a case of a 13-year - old girl , referred to the department of ophthalmology , faculty of medicine , kafkas university , kars , turkey from the emergency room , who had developed a metoclopramide - induced oculogyric crisis .
a 13-year - old female patient presented to the emergency department with double vision and involuntary upward and lateral deviation of the eyes .
three days earlier , she had presented at an outpatient clinic and metoclopramide therapy was started at 0.5 mg / kg three times daily for vomiting of 2 days duration . after treatment , the frequency of vomiting was reduced , but her eyes became deviated upward , starting from 30 minutes before presentation ( figure 1 ) . on initial presentation , she was aware of this situation and was in severe distress . on neurological examination , her consciousness was clear .
sustained conjugate upward and lateral deviation of the eyes ( oculogyric crisis ) , and neck stiffness when only the neck muscles were contracted , were observed .
the patient could bring her eyes back to primary position with extreme effort , but she could not sustain the effort , and the eyes resumed their eccentric position within seconds . on ophthalmic examination , she exhibited isocoria , with her pupils giving indirect and direct light reflexes .
ocular motility and visual acuity could not be evaluated due to the presence of oculogyric crisis .
vitals were normal and results of complete blood count , liver and kidney function tests , and electrolytes were within normal values .
based on the history and physical examination findings , a diagnosis of metoclopramide - induced dystonia was made .
the drug was discontinued and the patient was treated with intravenous diphenhydramine 1 mg / kg . the symptoms disappeared rapidly , within 30 minutes of commencing treatment , and the patient was discharged after approximately 4 hours of admission with complete recovery .
acute dystonic reactions are extrapyramidal side effects due to alteration of the dopaminergic  cholinergic balance in the nigrostriatum.7 medication - induced acute dystonia can be a side effect of treatment with antiemetics , antipsychotics , antidepressants , antiepileptics , antimalarials , and other drugs.7,8 such drugs produce acute dystonic reactions through a nigrostriatal dopamine d2 receptor blockade , which results in an excess of striatal cholinergic output.9 these drug - induced side effects are dose independent.8 metoclopramide , the most commonly prescribed antiemetic , may cause acute dystonic reactions at any age even if it is used at therapeutic dosages .
the incidence of these reactions secondary to metoclopramide is 0.2% , but in old and young patients this incidence increases to as high as 25%.5 metoclopramide - induced side effects are also known to appear more frequently in female patients , at high drug doses , in patients with a family history of neurological disease , in those who are treated with neuroleptics , and in patients whose family members have developed acute dystonic reactions due to metoclopramide.5,10,11 acute dystonic reactions include contractions of the muscles , especially in the facial , trapezius , and dorsal levator scapulae and rhomboid muscles ; opisthotonus ; torticollis ; dysarthria ; trismus ; and oculogyric crisis.4 oculogyric crisis is characterized by a temporary period of frequent spasms of eye deviation , particularly upward , each spasm lasting from seconds to hours and the entire episode lasting from days to weeks.8,12 the spasm may be preceded or accompanied by disturbing emotional symptoms , including anxiety , restlessness , compulsive thinking , sensations of increased brightness , or distortions of visual background.13 although oculogyric crisis usually occurs as a side effect of drugs , it can be seen in patients with postencephalitic parkinsonism , brainstem encephalitis , wilson s disease , and cystic glioma , for whom the onset of the crisis is positional.1417 versive seizures , paroxysmal tonic upward gaze , eye movement tics , and retinal disease must also be excluded from the differential diagnosis .
wyllie et al defined versive seizures as clonic or tonic head and eye deviations , unquestionably forced and involuntary , resulting in sustained unnatural positioning of the head and eyes.18 versive seizures with upgaze deviation can simulate oculogyric crises , but they are associated with an alteration of consciousness and electroencephalogram abnormalities.18 paroxysmal tonic upward gaze is characterized by infantile or early childhood onset , with episodes of sustained conjugate upward deviation of the eyes .
it can be distinguished from oculogyric crisis by the presence of neck flexion and concomitant episodic ataxia.19 eye movement tics in children are seen between the ages of 6 and 12 years and are characterized by a stereotyped conjugate deviation of the eyes upward and outward .
oculogyric crisis is more sustained than eye movement tics.20 in our case , neurologic and ophthalmologic examinations and vitals were normal .
the results of complete blood count , liver and kidney function tests , and electrolytes were within normal values . based on the history and physical examination findings , a diagnosis of metoclopramide - induced dystonia was made .
although the incidence of metoclopramide - induced acute dystonic reactions has been reported to be 25% in children , there have been few cases published on oculogyric crisis in general.5,6 without a thorough history , symptoms can be confused with other diseases , such as partial epileptic seizure with versive movements and eye movement tics .
it is necessary for ophthalmologists to recognize this ocular side effect in children with oculogyric crisis , because recognizing this adverse effect could help avoid the trouble of going through detailed and exhaustive neurological examinations and investigations .
oculogyric crisis is an acute dystonic reaction of the ocular muscles characterized by bilateral dystonic elevation of visual gaze lasting from seconds to hours . 
 this reaction is most commonly explained as an adverse reaction to drugs such as antiemetics , antipsychotics , antidepressants , antiepileptics , and antimalarials . 
 although the incidence of metoclopramide - induced acute dystonic reactions has been reported as 25% in children , there have been few published cases on oculogyric crisis in general . 
 it is important to be able to recognize this ocular side effect because , without a thorough patient history , symptoms can be confused with other diseases such as versive seizures , paroxysmal tonic upward gaze , and encephalopathy . in this paper , we report a case of oculogyric crisis induced by metoclopramide .