**Question:** Extrapyramidal side-effect least seen with ?

A. Dopamine agonists
B. Anticholinergics
C. Monoamine oxidase inhibitors
D. Antipsychotics

**Correct Answer: C. Monoamine oxidase inhibitors**

**Core Concept:**
Extrapyramidal side-effects (EPS) are a group of symptoms that occur due to medication-induced disruption in the normal functioning of the extrapyramidal system, which is a part of the basal ganglia complex in the brain. This system controls muscle movements and coordination. EPS can manifest as various symptoms such as tremors, stiffness, and postural instability.

**Why the Correct Answer is Right:**
Monoamine oxidase inhibitors (MAOIs) are a class of medications used primarily for the treatment of depression and certain neurological conditions. They work by inhibiting the enzyme monoamine oxidase, which helps to increase the levels of certain neurotransmitters such as serotonin, norepinephrine, and dopamine in the brain. Unlike the other options, MAOIs do not significantly affect dopamine levels, which helps to explain why they are less likely to cause extrapyramidal side-effects.

**Why Each Wrong Option is Incorrect:**

A. Dopamine agonists: These medications work by mimicking dopamine, a neurotransmitter involved in motor control and coordination. Since dopamine agonists directly affect dopamine levels, they are more likely to cause EPS compared to MAOIs.

B. Anticholinergics: These medications interfere with the action of acetylcholine, a neurotransmitter involved in muscle contraction and smooth muscle relaxation. Anticholinergics can exacerbate the symptoms of EPS by blocking the action of acetylcholine, which further impairs motor control.

C. Antidepressants (excluding MAOIs): Most antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), primarily affect serotonin and norepinephrine, neurotransmitters involved in mood regulation and stress response, respectively. Since these agents primarily target these neurotransmitters, they are less likely to cause EPS compared to dopamine agonists, anticholinergics, and antipsychotics.

D. Antipsychotics: These medications are primarily used to treat psychotic disorders like schizophrenia. They act by blocking dopamine receptors, leading to a decrease in dopamine levels in the brain, which can result in extrapyramidal side-effects due to the disruption of dopaminergic neurotransmission.

**Clinical Pearl:** Extrapyramidal side-effects are more commonly seen in individuals with pre-existing neurological disorders such as Parkinson's disease, as they have an increased sensitivity to the dopaminergic blockade caused by antipsychotics. In such patients, the use of antipsychotics should be approached with caution, and the benefits of treatment should be carefully weighed against the potential risks of EPS.

**Core Concept:** The extrapyramidal side-effects are caused