TARDIVE DYSKINESIA 2019-09-03T11:41:10-04:00

Tardive Dyskinesia

NORD gratefully acknowledges Daniel Tarsy, MD, Professor in Neurology, Harvard Medical School; Director, Parkinson’s Disease & Movement Disorders Center, Beth Israel Deaconess Medical Center, for assistance in the preparation of this report.

Synonyms of Tardive Dyskinesia

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

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.

Signs & 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 depression, some digestive disorders, and other neurologic illnesses.

Standard Therapies

Treatment
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.

In 2017, Ingrezza (valbenazine) was FDA approved to treat adults with tardive dyskinesia. Ingrezza is manufactured by Neurocrine Biosciences, Inc.

In 2017, Austedo (deutetrabenazine) was FDA approved for the treatment of tardive dyskinesia in adults. Austedo is manufactured by Teva Pharmaceutical Industries Ltd.

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

Some current clinical trials also are posted on the following page on the NORD website:
https://rarediseases.org/for-patients-and-families/information-resources/news-patient-recruitment/

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com

For information about clinical trials conducted in Europe, contact:
https://www.clinicaltrialsregister.eu/

Supporting Organizations

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.Medscape. Updated: Updated: Apr 23, 2017. http://emedicine.medscape.com/article/1151826-overview Accessed June 11, 2018.

NINDS Tardive Dyskinesia Information Page.3/2018. https://www.ninds.nih.gov/Disorders/All-Disorders/Tardive-Dyskinesia-Information-Page Accessed June 11, 2018.

Online Mendelian Inheritance in Man (OMIM). Victor A. McKusick, Editor; Johns Hopkins University, Last update 03/31/2009. Entry Number 272620. Available at: http://omim.org/entry/272620 Accessed June 11, 2018.

Years Published

1987, 1989, 1995, 1998, 1999, 2007, 2009, 2012, 2015, 2018

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