Tardive Dyskinesia

Tardive Dyskinesia

National Organization for Rare Disorders, Inc.

Important

It is possible that the main title of the report Tardive Dyskinesia is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.

Synonyms

  • TD
  • linguofacial dyskinesia
  • oral-facial dyskinesia
  • tardive dystonia
  • tardive oral dyskinesia

Disorder Subdivisions

  • None

General Discussion

Tardive dyskinesia (TD) is an involuntary neurological movement disorder caused by the use of dopamine receptor blocking drugs that are prescribed to treat certain psychiatric or gastrointestinal conditions. Long-term use of these drugs may produce biochemical abnormalities in the area of the brain known as the striatum. The reasons that some people who take these drugs may get tardive dyskinesia, and some people do not, is unknown. Tardive dystonia is a more severe form of tardive dyskinesia in which slower twisting movements of the neck and trunk muscles are prominent.

Symptoms

Tardive dyskinesia is characterized by involuntary and abnormal movements of the jaw, lips and tongue. Typical symptoms include facial grimacing, sticking out the tongue, sucking or fish-like movements of the mouth. In some cases, the arms and/or legs may also be affected by involuntary rapid, jerking movements (chorea), or slow, writhing movements (athetosis). Symptoms of tardive dystonia include slower, twisting movements of larger muscles of the neck and trunk as well as the face.

Causes

Tardive dyskinesia is caused by long-term use of a class of drugs known as neuroleptics. Neuroleptic drugs are often prescribed for management of certain mental, neurological, or gastrointestinal disorders. Metoclopramide and prochlorperazine are drugs used for chronic gastrointestinal conditions that may cause tardive dyskinesia. Neuroleptic drugs block dopamine receptors in the brain. Dopamine is a neurotransmitter which is a chemical that helps brain cells to communicate. Although most cases occur after a person has taken these drugs for several years, some cases may occur with shorter use of neuroleptic drugs.

Affected Populations

Tardive dyskinesia affects individuals who have been taking neuroleptic drugs for a long period of time. A high percentage of schizophrenic people who have spent long periods of time taking these drugs have a high risk of developing TD. However, neuroleptic drugs are also prescribed for some digestive disorders and other neurologic illnesses.

Standard Therapies

Treatment of tardive dyskinesia initially consists of discontinuing the neuroleptic drug as soon as involuntary facial, neck, trunk, or extremity movements are identified in people taking neuroleptic drugs if this is felt to be safe psychiatrically. Use of an "atypical" neuroleptic drug is often used in place of traditional neuroleptics if felt to be psychiatrically appropriate. However, the "atypical" neuroleptic drugs are also capable of causing or perpetuating tardive dyskinesia. In some cases, physicians may be forced to reinstitute a neuroleptic drug if the tardive dyskinesia symptoms do not disappear and become very severe after medication is discontinued.

Investigational Therapies

Studies are ongoing to determine possible new drug therapies for the treatment of tardive dyskinesia. Choline, lithium, bromocriptine, baclofen, methyldopa, valproate, clonidine, propranolol, amantadine, clonazepam, and nifedipine have occasionally been helpful but in most cases do not improve dyskinesia. Tetrabenazine is often useful for symptomatic treatment of tardive dyskinesia and is currently available for use in the US. However, it carries the risk of causing or aggravating depression. Other experimental drugs are being tested to reduce or eliminate the symptoms of tardive dyskinesia. For more information about these studies, please contact the agencies listed in the Resources section of this report.



Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. Government funding, and some supported by private industry, are posted on this government web site.



For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:



Tollfree: (800) 411-1222

TTY: (866) 411-1010

Email: prpl@cc.nih.gov



For information about clinical trials sponsored by private sources, contact:

www.centerwatch.com

References

TEXTBOOKS

Internal Medicine, 2nd Ed.: Jay H. Stein, ed.-in-chief; Little, Brown and Co., 1987. Pp. 2160.



Diagnostic and Statistical Manual of Mental Disorders: DSM IV, 4th Ed.: A. Frances et. al., Editors; American Psychiatric Association, 1994. Pp. 679-80 & 747-49.



Treatments of Psychiatric Disorders, 2nd Ed.: Glen O. Gabbard, M.D., Editor; American Psychiatric Association, 1995. Pp. 985-86.



JOURNAL ARTICLES

Incidence of Tardive Dyskinesia in Early Stages of Low-Dose Treatment with Typical Neuroleptics in Older Patients. D. V. Jeste et al.; Am J Psychiatry (Feb 1999; 156(2)). Pp. 309-11.



Randomised Double-Blind Comparison of the Incidence of Tardive Dyskinesia in Patients with Schizophrenia Durling Long-Term Treatment with Olanzapine or Haloperidol. C. M. Beasley et al.; Br J Psychiatry (Jan 1999; 174). Pp. 23-30.



Managing Antipsychotic-Induced Tardive Dyskinesia. G. Gardos; Drug Saf (Feb 1999; 20(2).

Conventional vs Newer Antipsychotics in Elderly Patients. D. V. Jeste et al.; Am j Geriatr Psychiatry (Winter 1997; 7(1)). Pp. 70-76.

Pp. 187-93.



Tardive Dyskinesia in Affective Disorders. J. M. Kane; J Clin Psychiatry (1990; 60(5)). Pp. 43-47.



Facial Dyskinesia. J. Jankovic et al.; Adv Neurol (1988). P. 49.

Suppression of Tardive Dyskinesia with Amoxapine: Case Report. D. A. DMello et al.; J Clin Psychiatry (Mar 1986; 47(3)). P. 148.



INTERNET

Brasic, JR. Tardive Dyskinesia. eMedicine. Updated:January 21, 2010. http://emedicine.medscape.com/article/1151826-overview. Accessed on:January 19, 2012.



NINDS Tardive Dyskinesia Information Page. Updated:October 4, 2011. http://www.ninds.nih.gov/disorders/tardive/tardive.htm Accessed on: January 19, 2012.



Online Mendelian Inheritance in Man (OMIM). Victor A. McKusick, Editor; Johns Hopkins University, Last Edit Date 3/31/09, Entry Number 272620. http://omim.org/entry/272620 Accessed on:January 19, 2012.

Resources

WE MOVE (Worldwide Education and Awareness for Movement Disorders)

5731 Mosholu Avenue

Bronx, NY 10471

USA

Tel: (347)843-6132

Fax: (718)601-5112

Email: wemove@wemove.org

Internet: http://www.wemove.org



Dystonia Medical Research Foundation

1 East Wacker Drive, Suite 2810 East Wacker Drive

Suite 2810

Chicago, IL 60601-1905

United States

Tel: (312)755-0198

Fax: (312)803-0138

Tel: (800)377-3978

Email: dystonia@dystonia-foundation.org

Internet: http://www.dystonia-foundation.org



Mental Health America

2000 N. Beauregard Street, 6th Floor

Alexandria, VA 22314-2971

USA

Tel: (703)684-7722

Fax: (703)684-5968

Tel: (800)969-6642

TDD: (800)433-5959

Email: infoctr@mentalhealthamerica.net

Internet: http://www.mentalhealthamerica.net/



National Alliance on Mental Illness

3803 N. Fairfax Drive

Suite 100

Arlington, VA 22203-

Tel: (703)524-7600

Fax: (703)524-9094

Tel: (800)999-6264

TDD: (703)516-7227

Email: membership@nami.org

Internet: http://www.nami.org



NIH/National Institute of Mental Health

Health Science Writing, Press and Dissemination Branch

6001 Executive Boulevard

Room 8184, MSC 9663

Bethesda, MD 20892-9663

Tel: (301)443-4513

Fax: (301)443-4279

Tel: (866)615-6464

TDD: (301)443-8431

Email: nimhinfo@nih.gov

Internet: http://www.nimh.nih.gov/index.shtml



NIH/National Institute of Neurological Disorders and Stroke

P.O. Box 5801

Bethesda, MD 20824

Tel: (301)496-5751

Fax: (301)402-2186

Tel: (800)352-9424

TDD: (301)468-5981

Internet: http://www.ninds.nih.gov/



Dystonia Society

89 Albert Embankment, 2nd Floor

Vauxhall

London, SE1 7TP

United Kingdom

Tel: 08454586211

Fax: 08454586311

Tel: 08454586322

Email: angie@dystonia.org.uk

Internet: http://www.dystonia.org.uk



Genetic and Rare Diseases (GARD) Information Center

PO Box 8126

Gaithersburg, MD 20898-8126

Tel: (301)251-4925

Fax: (301)251-4911

Tel: (888)205-2311

TDD: (888)205-3223

Internet: http://rarediseases.info.nih.gov/GARD/



American Dystonia Society

17 Suffolk Lane

Suite 1

Princeton Junction, NJ 08550

Tel: (310)237-5478

Fax: (609)275-5663

Email: info@dystonia.us

Internet: http://www.dystonia.us



For a Complete Report

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