• Tardive Dyskinesia

    (TD)

    Definition

    Tardive dyskinesia (TD) is a neurologic syndrome. It results from using neuroleptic drugs—also called antipsychotic drugs. This class of drugs is used to treat psychiatric conditions, like schizophrenia . TD consists of a group of symptoms including:
    • Abnormal twisting movements
    • Abnormal postures due to sustained muscle contractions

    Causes

    It is unclear exactly why TD develops. Long-term use of neuroleptic drugs can cause changes in the chemistry in the brain that lead to the symptoms. Nerve cells may also become overly sensitive to certain substances, such as neurotransmitters in the brain. Not everyone who takes these drugs develops TD.

    Risk Factors

    Factors that may increase your risk of TD include:
      Use of neuroleptic drugs, especially if the drugs:
      • Are taken in high doses and longer than six months
      • Are first generation drugs
    • Use of metoclopramide and prochlorperazine—These medicines are used to treat gastrointestinal problems, like nausea, vomiting, delayed bowel emptying, and gastroesophageal reflux disease (GERD), especially if taken more than three months.
    • Age: 54 or older
    • Sex: female
    • Possible genetic factor
    • Having a disease that may require using neuroleptic drugs, such as:
    • Mood disorders or other psychiatric disorders
    • Behavior problems that occur with psychiatric or neurologic disorders, such as agitation in Alzheimer’s disease
    • Digestive disorders such as:
    • Parkinsonism caused by neuroleptic drugs

    Symptoms

    TD causes repetitive movements. Movements usually occur in the face, mouth, limbs, or trunk. The movements are involuntary and serve no purpose. They may occur occasionally or all of the time. They may or may not be noticeable. Symptoms may begin while on the drug or within weeks of stopping it. They can worsen with:
    • Stress
    • Moving other parts of the body
    • Taking certain drugs
    Symptoms my decrease with:
    • Relaxation
    • Sleep
    • Purposely moving the affected body part
    Symptoms may include:
    • Grimacing
    • Sticking out the tongue
    • Twisting the tongue
    • Chewing
    • Sucking
    • Smacking lips
    • Puckering lips
    • Blinking eyes
    • Facial tics
    • Foot tapping
    • Moving fingers as if playing the piano
    • Rapidly moving arms, legs, or body
    • Writhing movements
    • Pelvic thrusts
    • Grunting
    • Sighing
    • Noisy breathing

    Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done. Other disorders can cause symptoms similar to those of TD. The doctor will rule out other disorders before making a diagnosis. There is no specific test for TD.
    Tests may include:
    • Your bodily fluids may be tested. This can be done with blood tests.
    • Pictures may be taken of structures inside your head. This can be done with:
    CT Scan of the Head
    CT Scan of the Head
    Copyright © Nucleus Medical Media, Inc.

    Treatment

    To treat TD, your doctor may:
    • Stop the neuroleptic medicine
    • Lower the dose
    • Switch you to a different medicine, such as an atypical antipsychotic
    • Recommend vitamin B6 or vitamin E to reduce the risk of worsening symptoms—These vitamins are still being studied.
    Symptoms may decrease over time even if you continue to take the neuroleptic drug. Younger people tend to do better.

    Medication

    Some medicines may help decrease symptoms, such as:
    • Melatonin
    • Trihexyphenidyl
    • Reserpine
    • Propranolol
    • Clonidine
    • Baclofen
    • Sedatives, such as:
      • Diazepam
      • Clonazepam
      Antiseizure drugs, such as:
      • Valproic acid
      • Levetiracetam
    • Antipsychotic drugs that may help with movement disorders, such as sulpiride, oxypertine, tiapride and other medicines, such as L-dopa, which is a type of amino acid.
    • Diphenhydramine

    Surgery

    Deep Brain Stimulation (DBS) is being evaluated for the treatment of TD.

    Prevention

    If you need neuroleptic drugs to control a psychiatric disorder, consider these guidelines to help prevent TD:
      Talk with your doctor about:
      • Risks and benefits of the medicine
      • Whether the dose is right for you and how well the drug is working
      • Other medicines you can try that have less risk of TD
      • Whether you can take a drug holiday, to take a break from using the medicine
      • Even a small symptom of TD that you have—Early treatment works best.
    • Do not stop taking your medicine without first talking to your doctor. If you stop the drug right away, it may trigger TD.
    • See your doctor every three months.

    RESOURCES

    National Alliance on Mental Illness http://www.nami.org

    National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov

    CANADIAN RESOURCES

    Canadian Mental Health Association http://www.ontario.cmha.ca

    Mental Health Canada http://www.mentalhealthcanada.com

    References

    Bai YM, Yu SC, Lin CC. Risperidone for severe tardive dyskinesia: a 12-week randomized, double-blind, placebo-controlled study. J Clin Psychiatry . 2003;64:1342-1348.

    Bradley WG, Daroff RB, Fenichel G, Jankovic J. Neurology in Clinical Practice. 4th ed. Butterworth Heinemann; 2003. Accessed November 4, 2007.

    Cecil RL, Goldman L, Bennett JC. Cecil Textbook of Medicine . 21st ed. Philadelphia, PA: WB Saunders Co; 2000.

    Conn HF, Rakel RE. Conn's Current Therapy 2001 . 53rd ed. Philadelphia, PA: WB Saunders Co; 2001.

    Dambro M. Griffith's 5-Minute Clinical Consult . Baltimore, MD: Lippincott Williams & Wilkins; 2001.

    Damier P. Drug-induced dyskinesias. Curr Opin Neurol . 2009;22(4):394-399.

    Goroll A, Mulley A. Primary Care Medicine . 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000.

    Kinon BJ, Jeste DV, Kollack-Walker S, Stauffer V, Liu-Seifert H. Olanzapine treatment for tardive dyskinesia in schizophrenia patients: a prospective clinical trial with patients randomized to blinded dose reduction periods. Prog Neuropsychopharmacol Biol Psychiatry . 2004;28:985-996.

    McGrath JJ, Soares KV. Neuroleptic reduction and/or cessation and neuroleptics as specific treatments for tardive dyskinesia. Cochrane Database Syst Rev . 2006;CD000459.

    Meco G, Fabrizio E, Epifanio A, et al. Levetiracetam in tardive dyskinesia. Clin Neuropharmacol . 2006;29:265-268.

    Noble J, Greene HL. Textbook of Primary Care Medicine . 3rd ed. St. Louis, MO: Mosby Inc; 2001.

    Pham DQ, Plakogiannis R. Vitamin E supplementation in Alzheimer’s disease, Parkinson’s disease, tardive dyskinesia, and cataract: part 2. Ann Pharmacother . 2005;39(12):2065-72.

    Sachdev PS. The current status of tardive dyskinesia. Australian and New Zealand Journal of Psychiatry . 2000;34:355-369.

    Soares KV, McGrath JJ. The treatment of tardive dyskinesia: a systematic review and meta-analysis. Izophr Res. 1999;39(1):1-16.

    Tardive dyskinesia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated November 23, 2011. Accessed February 25, 2013.

    Tardive dyskinesia. National Alliance on Mental Illness website. Available at: http://www.nami.org/Content/ContentGroups/Helpline1/Tardive%5FDyskinesia.htm. Updated September 2003. Accessed February 25, 2013.

    Tasman A, Kay J, Lieberman J. Psychiatry . Philadelphia, PA: WB Saunders Co; 1997.

    Thema B, Srivastava V, Tiwari AK. Genetic underpinnings of tardive dyskinesias: passing the baton to pharmacogenetics. Pharmacogenomics. 2008;9:1285-1306.

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