Definition

Tardive dyskinesia (TD) is a neurologic syndrome. It results from prolonged use of neuroleptic drugs (also called antipsychotic drugs). This class of drugs is used to treat psychiatric conditions, like schizophrenia . TD consists of:

• 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

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for TD include:

• Use of neuroleptic drugs, especially if:
  • Taken in high doses
  • Taken for a long time, especially more than six months
• Use of metoclopramide (Reglan)—This medication is used to treat gastrointestinal problems, like 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 use of neuroleptic drugs, such as:
  • Mood disorders or other psychiatric disorders
  • Behavior problems that occur with psychiatric or neurologic disorders (eg, agitation in Alzheimer’s disease)
  • Digestive disorders such as:
    • Esophageal reflux
    • Nausea and vomiting
    • Diabetes—Diabetic gastroparesis may require the medicine metoclopramide.
  • 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 be barely noticeable or very pronounced. 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. She will also do a physical exam. 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:

• Blood tests to check electrolytes and blood chemistry
• CT scan —a type of x-ray that uses a computer to make pictures of structures inside the head
• MRI scan —a test that uses magnetic waves to make pictures of structures inside the brain

CT Scan of the Head

© 2009 Nucleus Medical Media, Inc.

Treatment

To treat TD, your doctor may:

• Stop the neuroleptic medication
• Lower the dose
• Switch you to a different medication (eg, 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.

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 every three months.