Tardive Dystonia due to D2 Antagonists and Other Agents

Abstract

Tardive dystonia due to D2 antagonists or other agents is a potentially severe extrapyramidal side effect emerging after long-term drug treatment, prevalent but not limited to psychiatric populations. Its course is often deteriorating, and available treatments are frequently far from satisfying. It presents with sustained muscle contractions, abnormal postures, and repetitive twisting movements and leads to increased psychiatric morbidity, mortality, and decline of quality of life. Inadequate clinical skill and awareness of tardive dystonia can lead to neglect or misdiagnoses, considered as conversion symptoms or of psychogenic origin. Since the syndrome is persistent and often treatment resistant, prevention should be a mainstay of clinical care. Emerging evidence supports positive effects of atypical antipsychotics, particularly quetiapine and clozapine. Therapies such as tetrabenazine, valbenazine, deutetrabenazine, anticholinergics, baclofen, benzodiazepines, vitamin E, or non-pharmacologic interventions, namely botulinum toxin A, deep-brain stimulation, have been found to be helpful in some cases of tardive dystonia. This chapter comprehensively illustrates multiple aspects of this entity, including recent advances on etiology, pathophysiology, clinical presentation, epidemiology, pharmacogenomics, and treatment, aiming to enhance and deepen clinicians' and researchers' awareness of tardive dystonia, with the final goal of ameliorating patients' prognosis and quality of life.

Spotlight on Oculogyric Crisis: A Review

“…These effects are more pronounced with tardive dystonia cases and can even lead to social avoidance, isolation, and stigmatization. 59 Hence, both non-motor and motor features associated with dystonia should be managed in order to improve the quality of life.…”

Heterogeneous tardive syndromes are still treatable with quetiapine

“…22 Multiple review papers have commented on the impure and heterogenous nature of tardive syndromes previously. [23][24][25] Additionally, a 1999 study of 100 individuals with TD showed 35% had two or more of the following TS: CTD; tardive tremor; tardive akathisia; tardive dystonia; tardive tics, and myoclonus. 26 However only 16% had tardive dystonia and 4% had tardive tics.…”

“…A single‐blind randomised trial involved 45 patients, which compared quetiapine and haloperidol for treating CTD showed favourable results for quetiapine 22 . Multiple review papers have commented on the impure and heterogenous nature of tardive syndromes previously 23–25 . Additionally, a 1999 study of 100 individuals with TD showed 35% had two or more of the following TS: CTD; tardive tremor; tardive akathisia; tardive dystonia; tardive tics, and myoclonus 26 .…”

Polypharmacy-Associated Tardive Dystonia Responding to Clozapine Optimization

“…1 TD is a well-recognized subtype of tardive dyskinesia, characterized by slow involuntary sustained twisting movements often painful, affecting face, neck, limbs, or trunk. [1][2][3] We report a patient with severe axial tardive dystonia after psychotropic polypharmacy who responded to clozapine optimization.…”

“…In our patient, olanzapine and amisulpride could be incriminated for precipitating TD because the chances of having TD with clozapine or quetiapine exposure is extremely rare due to their low D2 affinity and fast dissociation property. 3…”