Treatment of tardive dystonia: A review

Abstract

Tardive dystonia (TD), the second most common but most disabling form of tardive syndrome, was initially described in 1982. It is caused by exposure to dopamine receptor blocking agents including antipsychotics and antiemetics. It most commonly presents as cranial or cervical dystonia. Characteristics suggestive of a TD diagnosis include a young age of onset, male predominance, and the higher prevalence of phasic cervical dystonia and retrocollis. Treatment of TD is limited. In this paper we review the literature on treatment options for TD as well as discussing a strategic approach. Options include use of clozapine which appears to have anti-dystonia properties. Other medications reported on with limited evidence include VMAT2 inhibitors, anticholinergics, clonazepam, and baclofen. Botulinum toxin has been shown to provide relief in TD in a manner similar to primary dystonia. The largest literature is on the use of deep brain stimulation (DBS) of the globus pallidus pars interna which includes blinded studies. We finish with providing an algorithm based on current knowledge.

Clinical Evolution of Tardive Cervical Dystonia from Antecollis to Retrocollis

“…Considering that remission is rare even with causal agent suspension and that the best treatment is still debated, it is crucial to be careful in the moment of choosing an antipsychotic agent and trying to balance antipsychotic potency and extrapyramidal effects [ 1 , 4 , 6 , 9 ]. The best medical treatment of TD has been described as limited but the first step in treatment is discontinuation of antipsychotics [ 10 ]. If discontinuation is not possible, it is acceptable to change from first-generation antipsychotics to second-generation antipsychotics.…”