Tardive Tourette-like syndrome

Fountoulakis, Konstantinos Ν.; Samara, Myrto; Siapera, Marianna; Iacovides, Apostolos

doi:10.1097/yic.0b013e32834aa924

Cited by 25 publications

(11 citation statements)

References 57 publications

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“…"Tardive tics", indistinguishable from Tourette's Syndrome [117] and "tardive myoclonus" affecting upper extremities [118] have been described as well. Stereotypies have been equivocally defined as they have been confounded with classical TD [75].…”

Section: Clinical Featuresmentioning

confidence: 99%

Current Methods for the Treatment and Prevention of Drug-Induced Parkinsonism and Tardive Dyskinesia in the Elderly

Estévez-Fraga¹,

Zeun²,

Moreno

2018

Drugs Aging

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Drug induced parkinsonism and tardive dyskinesia are iatrogenic consequences of the use of antidopaminergic drugs. Both entities share risk factors, physiopathological mechanisms and to some degree, therapeutic approaches. Here we review both entities and discuss emerging therapies including the recently approved drug deutetrabenazine and relevant aspects for clinical practice such as new diagnostic techniques. Key points:-Drug induced parkinsonism and tardive dyskinesia are iatrogenic consequences of the use of antidopaminergic drugs.-DIP is considered a direct consequence of the blockage of D2 receptors while TD has a more complex physiopathology, including enhanced sensitivity of dopamine receptors.-Both entities are more frequent in older people due to a progressive loss of dopaminergic neurons with age.-New therapies are available for TD, including deutetrabenazine. Compliance with ethical Standards:Disclosure of potential conflicts of interest: no funding was received for this study.The risks of drug-induced parkinsonism/tardive dyskinesia in the elderly and current methods to overcome it. 1.-IntroductionTardive dyskinesia (TD) and drug-induced parkinsonism (DIP) are iatrogenic disorders caused by dopamine receptor blockers (DRB) [1]. They were recognized early after the introduction of antipsychotics[2] to the clinical practice, leading to the finding that DIP caused by reserpine, a dopamine depleter, was related to dopamine deficiency [3].Elderly patients are more susceptible to these side effects, probably due to an age-related decrease in nigral neurons and dopamine [4]. Since the introduction of newer second generation antipsychotics (SGA) the frequency and intensity of these side effects has improved [5] , [6] , [7] , [8] but there is still room for concern [9], [10].TD and DIP share risk factors, pathological mechanisms and management, and might coexist in one given subject. Latest available evidence has clarified some intriguing features of TD and DIP. Meanwhile, new medications to treat TD are now available, highlighting the importance of a thorough, updated, knowledge of this pathologies.This article offers a comprehensive review of the incidence, clinical features and mechanisms behind DIP and TD. The benefits and risks of previous available drugs and those that have been recently approved by regulatory agencies are discussed. Drug induced Parkinsonism DefinitionDIP occurs when symptoms emerge after exposure to drugs, usually those that either deplete dopamine storages [11] or block dopamine receptors [12]. By definition, symptoms should be reversible, six months after the offending agent has been withdrawn[13] but actually up to 20% of patients develop persistent deficits despite drug discontinuation [14] leading to the hypothesis that these patients might have subclinical Parkinson's Disease (PD) unmasked by neuroleptic exposure (umPD), complicating the differential diagnosis [15], especially between aged patients, who are more prone to both PD and DIP. Epidemiology and risk factorsAfter PD, DI...

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Section: Clinical Featuresmentioning

confidence: 99%

Current Methods for the Treatment and Prevention of Drug-Induced Parkinsonism and Tardive Dyskinesia in the Elderly

Estévez-Fraga¹,

Zeun²,

Moreno

2018

Drugs Aging

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“…There is also a tardive form of Tourette disorder that follows the course of tardive dyskinesia and is usually seen accompanying the more typical signs of tardive dyskinesia. 75,76 For the remaining discussion of the differential diagnosis of antipsychotic-induced movement disorders, we have prepared Figure 1, which illustrates the relative preferred somatic region involved in mild to moderate cases of antipsychotic-induced akathisia, tardive dyskinesia, dystonia, and parkinsonian tremor. This differential distribution is often extremely helpful in making a diagnosis.…”

Section: Psychomotor Agitationmentioning

confidence: 99%

“…Patients who have both tics and akathisia can readily tell the difference in the subjective experience, as tics are not experienced as restlessness, but rather as a buildup of an uncomfortable feeling in a specific body part that culminates in a motor or phonic tic. There is also a tardive form of Tourette disorder that follows the course of tardive dyskinesia and is usually seen accompanying the more typical signs of tardive dyskinesia 75 , 76…”

Section: Recognition and Differential Diagnosismentioning

confidence: 99%

The clinical challenges of akathisia

et al. 2015

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Akathisia is one of the most vexing problems in neuropsychiatry. Although it is one of the most common side effects of antipsychotic medications, it is often difficult to describe by patients, and is difficult to diagnose and treat by practitioners. Akathisia is usually grouped with extrapyramidal movement disorders (ie, movement disorders that originate outside the pyramidal or corticospinal tracts and generally involve the basal ganglia). Yet, it can present as a purely subjective clinical complaint, without overt movement abnormalities. It has been subtyped into acute, subacute, chronic, tardive, withdrawal-related, and "pseudo" forms, although the distinction between many of these is unclear. It is therefore not surprising that akathisia is generally either underdiagnosed or misdiagnosed, which is a serious problem because it can lead to such adverse outcomes as poor adherence to medications, exacerbation of psychiatric symptoms, and, in some cases, aggression, violence, and suicide. In this article, we will attempt to address some of the confusion surrounding the condition, its relationship to other disorders, and differential diagnosis, as well as treatment alternatives.

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“…In addition, it is necessary to know that long-term treatment with neuroleptic, antiepileptic medication, or stimulants can cause tardive TS, which is characterized by the occurrence of multiple motor and vocal tics as well 128. As well as neuroleptics, some experts suggest that alpha-agonists such as clonidine or even guanfacine as first-line therapy have fewer adverse events 129.…”

Section: Discussionmentioning

confidence: 99%

Update on the role of antipsychotics in the treatment of Tourette syndrome

Huys¹,

Hardenacke²,

Poppe³

et al. 2012

NDT

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Tourette syndrome (TS) is a neuropsychiatric disorder with typical onset in childhood and characterized by chronic occurrence of motor and vocal tics. The disorder can lead to serious impairments of both quality of life and psychosocial functioning, particularly for those individuals displaying complex tics. In such patients, drug treatment is recommended. The pathophysiology of TS is thought to involve a dysfunction of basal ganglia-related circuits and hyperactive dopaminergic innervations. Congruently, dopamine receptor antagonism of neuroleptics appears to be the most efficacious approach for pharmacological intervention. To assess the efficacy of the different neuroleptics available, a systematic, keyword-related search in PubMed (National Library of Medicine, Washington, DC) was undertaken. Much information on the use of antipsychotics in the treatment of TS is based on older data. Our objective was to give an update and therefore we focused on papers published in the last decade (between 2001 and 2011). Accordingly, the present review aims to summarize the current and evidence-based knowledge on the risk-benefit ratio of both first and second generation neuroleptics in TS.

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Tardive Tourette-like syndrome

Cited by 25 publications

References 57 publications

Current Methods for the Treatment and Prevention of Drug-Induced Parkinsonism and Tardive Dyskinesia in the Elderly

Current Methods for the Treatment and Prevention of Drug-Induced Parkinsonism and Tardive Dyskinesia in the Elderly

The clinical challenges of akathisia

Update on the role of antipsychotics in the treatment of Tourette syndrome

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