Tardive Dyskinesia

Tardive Dyskinesia General Information

Tardive Dyskinesia is the general medical term used for a variety of repetitive involuntary movements which may appear as a side effect to dopamine antagonist type of drugs, especially when used in long term or high dose therapy. Such drugs that may cause this affection are antipsychotics, but other medications may have the same effect – it has been noted that some of the drugs used to treat neurological or gastrointestinal disorders may cause this condition. The notion “tardive” refers to the fact that this condition may appear or may continue even after discontinuation of the medication that has caused it.

Tardive Dyskinesia is common in 15 to 30 percent of the patients who have followed antipsychotic medication treatment for extended periods of time, typically for 3 months or more. A study has estimated the number of patients developing tics and involuntary movements at about 32% after 5 years’ use of such medication, with an increase of 5% per year, leading to the conclusion that prolonged use of such medication has a greater risk of this affection to occur as the therapy period increases. Also, it has been noted that female patients and elderly patients have higher risk factors in developing this disorder. Of course, the drug that is used also influences the chances for the condition to appear – for example, Haloperidol has a much greater risk factor than Perphenazine - , while the daily dose of medication is one of the greatest factors, apart from the duration of the treatment.

Tardive Dyskinesia Symptoms

Most cases of Tardive Dyskinesia are characterized by the appearance and persistence of a series of involuntary repetitive movements, which do not have any clear purpose. Among the most common such movements, facial movements seem to be the most common – grimacing, lip movements such as smacking, puckering or pursing, eye blinking or tongue protrusion. However, other movements can appear as well, such as movements involving the arms, legs or trunk. In some cases, the patient’s fingers are most affected by such movements, which can give the impression that the patient is playing some invisible musical instrument such as a piano or a guitar. In many cases, the patient is not aware of these gestures initially, until they are brought to their attention by people around them.

Variants of Tardive Dyskinesia may also appear, such as tardive akathisia – involving painful feelings of anxiety and inner tension. In such cases, the patient will feel a compulsory need to move the body, and severe cases are akin to an internal torture driving the patient in a perpetual need to move his or her body. Another variation of Tardive Dyskinesia is tardive tourettism – a condition which closely resembles the Tourette syndrome. In some cases, these two conditions may become so similar, that they can only be differentiated by closely examining the details of the onset of the actual condition from the typical Tourette details. In many such cases misdiagnose may appear.

Tardive Dyskinesia Treatment

The primary line of treatment against Tardive Dyskinesia should be prevention. In order to accomplish that, it is highly recommended that in cases requiring neuroleptic drug therapy, the lowest effective dose is employed for the shortest period of time possible. While this may not be possible in all situations, the possibility should be carefully examined by a specialized health care professional. Of course, once the Dyskinesia has been diagnosed the causative agent needs to be immediately discontinued. If treatment for the initial cause needs to be continued, the examining health care professional should closely weigh the risks of a permanent movement disorder against discontinuing the treatment.

In most cases where it is possible, treatment should employ drugs with the lowest risk of Tardive Dyskinesia. As such, atypical neuroleptics may be favored as they control psychosis while having a lower risk factor than regular neuroleptics. Clozapine is one of the most recommended medications in cases of patients that require further antipsychotic treatment which have developed Dyskinesia. While this drug may also cause this disorder, the incidence rate is much lower.

The actual treatment against Tardive Dyskinesia is comprised of oral anecdotal medication – such as Levodopa, Vitamin E, Benzodiazepines, Reserpine, Botulinum toxin, Tetrabenazine or dopamine-depleting agents. Discontinuation of anticholinergic medication – if present – may also allow a relief of the symptoms and an improvement in the patient’s condition. One drug that has been repeatedly used to treat this condition, and has so far proven to have a great positive effect in the alleviation of symptoms, is Clonazepam. Treatment with this drug may not be possible in all cases, and not all patients may experience an improvement in their condition; in such cases, alternative means of treatment should be employed.

Branched-chain amino acids have been reported to cause a great reduction in the spontaneous movements of patients affected by Tardive Dyskinesia. However, this type of therapy is contraindicated in the cases where the patient is pregnant. Further studies need to be performed in order to establish the effectiveness and safety of this treatment. While natural remedies have not been researched in scientific settings, they may have a beneficial effect in patients suffering from this condition. There have been reports that patients who alternate resting with regular exercise may experience an improvement in their condition, along with a negation of the symptoms. In most cases, such regimens are already employed as a general procedure aimed at the well-being of the patients.

As there is no regular treatment for Tardive Dyskinesia, the examining health care professional should closely weigh the benefits and the risks of the therapy before deciding what is the best course of action to follow. In most cases, in-depth knowledge of the patient’s general health condition and medical history is recommended. The examining health care specialist should also take into account the possible need to continue therapy for the initial condition, changing the initial medication with another one, with a lower risk factor or, if possible, terminating the treatment with that type of drug altogether. This may be possible in some cases where new medication is available, eliminating the aggravating factors for the condition.