An Update on Tardive Dyskinesia: From Phenomenology to Treatment

Abstract

Tardive dyskinesia (TD), characterized by oro-buccal-lingual stereotypy, can manifest in the form of akathisia, dystonia, tics, tremor, chorea, or as a combination of different types of abnormal movements. In addition to movement disorders (including involuntary vocalizations), patients with TD may have a variety of sensory symptoms, such as urge to move (as in akathisia), paresthesias, and pain. TD is a form of tardive syndrome-a group of iatrogenic hyperkinetic and hypokinetic movement disorders caused by dopamine receptor-blocking agents. The pathophysiology of TD remains poorly understood, and treatment of this condition is often challenging. In this update, we provide the most current information on the history, nomenclature, etiology, pathophysiology, epidemiology, phenomenology, differential diagnosis, and treatment of TD.

Movement Disorders From the Use of Metoclopramide and Other Antiemetics in the Treatment of Migraine

“…The term tardive dyskinesia (TD) is used to describe multiple phenomenologies that include classic tardive dyskinesia (CTD), as well as tardive dystonia , tardive akathisia , tardive tremor, and tardive tics among others . These are phenomenologically distinct movement disorders but share the same etiological background, namely recent exposure to DRBA.…”

“…Metoclopramide, prochlorperazine, and promethazine are among the most frequently used antinausea medications and their efficacy in acute migraine has been established in multiple studies . All 3 medications are dopamine receptor blocking agents (DRBA), also referred to as neuroleptics, and, therefore, have the potential to cause drug‐induced movement disorders (DIMD) that can be disabling and permanent . However, the risk of DIMD in migraine patients exposed to these drugs is not known.…”

BDNF as a pharmacogenetic target for antipsychotic treatment of schizophrenia

“…Acute EPS are one of the main causes of noncompliance with antipsychotic treatment, while TD has the most serious impact on quality of life for schizophrenia patients. TD is a motor system disorder and potentially irreversible side-effect that is characterised by repetitive and involuntary movements experienced by about 20-50% of patients treated with long-term antipsychotic drugs, especially for typical antipsychotics [38]. Serum BDNF levels are lower in schizophrenia patients with TD compared to those without TD [52].…”

Incidence of tardive dyskinesia: a comparison of long‐acting injectable and oral paliperidone clinical trial databases

“…Tardive dyskinesia (TD) is a serious movement disorder that manifests in many different forms, but typically involves repetitive uncontrolled involuntary movements of the face, jaw and lips. In more severe forms it can impact the trunk or limbs or both . The occurrence of TD is associated with long‐term treatment with several medication classes, including antimuscarinics, toxins, substances of abuse and antipsychotic medications .…”

“…acute extrapyramidal symptoms (EPS), psychosis, mood disorders, diabetes mellitus and organic brain dysfunction or damage]. Multiple types of acute EPS, such as parkinsonism, dystonia, akathisia, as well as dyskinesia, appear to increase the risk for TD . The potential of TD to be irreversible and severe can contribute to significant disability and social stigma for afflicted patients.…”