Are Second-Generation Antipsychotics Useful in Tardive Dystonia?

Abstract

The available evidence points to the effectiveness of clozapine as monotherapy and in combination with clonazepam for the treatment of TDt. When clozapine is not an option, olanzapine and quetiapine are reasonable alternatives. Given the lack of controlled trials, future focus should be on conducting randomized, placebo-controlled, multicenter, collaborative controlled clinical trials of several years' duration.

The Symptomatic Treatment of Acquired Dystonia: A Systematic Review

“…S24 A combination of clozapine with diazepam showed clear improvement on the BFMDRS. S28 Furthermore, the combination with clonazepam has been shown to be an effective treatment option in some patients, S11,S14 as also reported by Pinninti et al …”

“…S24 A combination of clozapine with diazepam showed clear improvement on the BFMDRS. S28 Furthermore, the combination with clonazepam has been shown to be an effective treatment option in some patients, S11,S14 as also reported by Pinninti et al 33 Another dopamine receptor blocker is quetiapine, which is an atypical antipsychotic similar to clozapine. Nineteen patients with tardive dystonia achieved long-lasting benefit from treatment with this drug.…”

Medical treatment of dystonia

“…Conflicting data revealed benefits in some studies, particularly in tardive dystonia [146, 155–157], but not in others [158, 159]. The use of the DRBAs as routine treatment for dystonia is generally discouraged due to the risk of engendering tardive syndromes [7, 160–162].…”

Tardive Dyskinesia Revisited-A Clinical Management Priority Perspective: A Voyage into High Dose Buspirone Part B

“…The jury is not fully in this regard but studies such as CATIE have enlightened a little [208][209][210][211][212][213]. I postulate that ultimately there will be a differential risk for TD amongst these SGAs partly based on higher selectivity for the Dopamine 2 or 2/3 receptors compared with the dopamine 1 family [214][215][216][217][218].…”

“…However, there are often contradictions. It's interesting looking at the early work and predictions on TD [200,234,[238][239][240][241][242][243][244][245][246][247][248][249][250] compared with the most recent ideas [20,48,101,152,154,210,211,[216][217][218][219]. These latter ideas have taken into account clarity on genes and genetics of TD where at best the jury is undecided, and also still show contradictory data.…”