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. Not everyone who takes these drugs develops TD.

Risk Factors

TD is more common in women and in people over the age of 54. Other factors that may increase your risk of TD include:

• Use of neuroleptic drugs, especially if the drugs:
  • Are taken in high doses for longer than 6 months
  • Are first generation drugs, which are the first drugs developed to treat a condition
• Use of metoclopramide and prochlorperazine—These medications are used to treat gastrointestinal problems, like nausea, vomiting, delayed bowel emptying, and gastroesophageal reflux disease (GERD), especially if taken more than 3 months
• Possible genetic factor
• Having a disease that may require using neuroleptic drugs, such as:
  • Mood or other psychiatric disorders
  • Behavior problems that occur with psychiatric or neurologic disorders, such as agitation in Alzheimer’s disease
  • Digestive disorders

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.

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

They can worsen with:

• Stress
• Moving other parts of the body
• Taking certain drugs

Symptoms may decrease with:

• Relaxation
• Sleep
• Purposely moving the affected body part

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 to rule out other disorders may include:

• Blood tests
• Imaging tests can evaluate the brain and surrounding structures. They may include:
  • CT scan
  • MRI scan

Treatment

To treat TD, your doctor may:

• Stop the neuroleptic medication
• Lower the dose
• Switch you to a different medication
• Recommend vitamin B6 or vitamin E, which may reduce the risk of worsening symptoms

Symptoms may decrease over time even if you continue to take the neuroleptic drug. Younger people tend to do better.

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 medication
  • Whether the dose is right for you and how well the drug is working
  • Other medications you can try that have less risk of TD
  • Whether you can take a drug holiday to take a break from using the medication
  • Even a small symptom of TD that you have—early treatment works best
• Do not stop taking your medication without first talking to your doctor. If you stop the drug right away, it may trigger TD.
• See your doctor on a regular basis as advised.

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

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

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

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(6):985-996.

McGrath JJ, Soares KV. Neuroleptic reduction and/or cessation and neuroleptics as specific treatments for tardive dyskinesia. Cochrane Database Syst Rev. 2006;(1):CD000459.

Meco G, Fabrizio E, Epifanio A, Morgante F, et al. Levetiracetam in tardive dyskinesia. Clin Neuropharmacol. 2006;29(5):265-268.

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):2065-2072.

Sachdev PS. The current status of tardive dyskinesia. Australian and New Zealand Journal of Psychiatry. 2000;34(3):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 July 29, 2013.

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