Tardive dyskinesia (syndrome): Current concept and modern approaches to its management

Abstract

Tardive dyskinesia is a serious, disabling and potentially permanent, neurological hyperkinetic movement disorder that occurs after months or years of taking psychotropic drugs. The pathophysiology of tardive dyskinesia is complex, multifactorial and still not fully understood. A number of drugs were tried for the management of this motor disturbance, yet until now no effective and standard treatment has been found. It is very disappointing to realize that the introduction of antipsychotics from the second generation has not significantly decreased the prevalence and incidence of tardive dyskinesia. Therefore, the management of this motor disturbance remains an actual topic as well as a challenge for clinicians. This review summarizes recent relevant publications concerning the treatment of tardive dyskinesia.

Identification and management of tardive dyskinesia: A case series and literature review

“…Based on currently available information, no confident statement can be made about the effectiveness of anticholinergics Tardive dyskinesia: identification and management 7 to treat TD and in fact benzhexol or benztropine or biperiden or orphenadrine or procyclidine or scopolamine or trihexyphenidyl, and other anticholinergics tend to aggravate abnormal movements and in some cases elicits abnormal movement not previously observed [41,43]. This evidence supports the hypothesis that anticholinergic therapy in patients prone to develop TD may increase the incidence of this disorder.…”

“…Clonazepam [41,[43][44][45][46] Studies of clonazepam the GABA-A agonist benzodiazepine (BZ) showed some effect in reducing TD [41,43]. Although no specific adverse effects would limit the usefulness of clonazepam in the elderly; the risk of drug interactions, psychomotor slowing, increased rate of falls with hip and femur …”

“…Ginkgo biloba [41,43,[47][48][49] Extract of Ginkgo biloba (EGb-761) which is considered a potent antioxidant with free radical-scavenging properties was found to decrease the symptoms of TD as measured by lower AIMS scores. Moreover, there seem to be also a carryover effect for at least six months after the discontinuation of EGb-761.…”

“…Clinicians should exercise a high degree of vigilance when prescribing these medications for pediatric patients [42]. The therapeutic effects of clonazepam and Ginkgo biloba in addition to the clinical effects of anticholinergics, anticholinergic medication withdrawal, botulinum toxin intramuscular injections, TBZ, LEV, propranolol and zolpidem are herein summarized below [43].…”

Drug or disease - Differentiating and managing motor symptoms associated with late onset Huntington’s disease from extrapyramidal side-effects of antipsychotics

“…It is usually nonreversible and has a prevalence rate of about 24% in a review conducted in 1988 [14]. However with the advent of newer atypical antipsychotics, a 2.5 fold reduction has been noted and the incidence rate at present is around 2% [15].…”