Skip to main content

Advertisement

SpringerLink
Log in

Tardive Dyskinesia

  • Movement Disorders
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

Tardive dyskinesia (TD) is iatrogenic (drug-induced); hence the best strategy is prevention. Try to limit exposure to any dopamine receptor blocking agents (DRBAs) if possible. These agents may be unavoidable in some psychiatric conditions such as schizophrenia, but alternative therapies can be used in many situations, such as in the treatment of depression, anxiety, gastrointestinal conditions, and other neurologic conditions, including migraines and sleep disorders. When DRBAs are necessary, physicians should prescribe the smallest possible dose and try to taper and stop the drug at the earliest signs of TD. Abrupt cessation should be avoided, as this can worsen symptoms of TD. Always discuss and document the possibility of TD as an adverse effect when starting patients on DRBAs. If TD is mild and tolerable, the withdrawal of the offending agent is possible, and exposure to DRBAs was short, physicians should consider avoiding treatment and waiting for spontaneous recovery. When treatment is necessary, tetrabenazine (TBZ) is considered a potential first-line agent and is known to be one of the most effective drugs in treating TD, but it is expensive and adverse effects such as depression, akathisia and parkinsonism frequently occur. Therefore, second-line agents with better tolerability profiles are often tried first in practice. These include amantadine, benzodiazepines, beta-blockers, and levetiracetam. When using TBZ, adverse effects should be aggressively monitored. (Depression often can be managed with antidepressants, for instance). In patients with psychosis, withdrawal of the antipsychotic may not be possible. Switching to clozapine or quetiapine is one option to minimize TD. When these agents are contraindicated and the patient must continue using other atypical antipsychotic drugs, try to add dopamine-depleting agents such as TBZ or reserpine, but watch for the development of parkinsonism. When the symptoms are focal, such as tongue protrusion or blepharospasm, botulinum toxin injections can be very effective if spontaneous recovery does not occur. As a last resort, when disabling, life-threatening symptoms of TD persist despite all of the above-mentioned methods, some advocate resuming treatment with the DRBA to suppress symptoms of TD. This has the potential to worsen TD in the long run.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Kruse W. Persistent muscular restlessness after phenothiazine treatment: report of 3 cases. Am J Psychiatry. 1960;117:152–3.

    PubMed  CAS  Google Scholar 

  2. Correll CU, Schenk EM. Tardive dyskinesia and new antipsychotics. Curr Opin Psychiatry. 2008;21(2):151–6.

    Article  PubMed  Google Scholar 

  3. Rapaport A, et al. Botulinum toxin for the treatment of oro-facial-lingual-masticatory tardive dyskinesia. Mov Disord. 2000;15(2):352–5.

    Article  PubMed  CAS  Google Scholar 

  4. Bateman DN, Rawlins MD, Simpson JM. Extrapyramidal reactions with metoclopramide. Br Med J (Clin Res Ed). 1985;291(6500):930–2.

    Article  CAS  Google Scholar 

  5. Wiholm BE, et al. Tardive dyskinesia associated with metoclopramide. Br Med J (Clin Res Ed). 1984;288(6416):545–7.

    Article  CAS  Google Scholar 

  6. Jeste DV, Wyatt RJ. Therapeutic strategies against tardive dyskinesia. Two decades of experience. Arch Gen Psychiatry. 1982;39(7):803–16.

    PubMed  CAS  Google Scholar 

  7. Kane JM, Woerner M, Lieberman J. Tardive dyskinesia: prevalence, incidence, and risk factors. J Clin Psychopharmacol. 1988;8(4 Suppl):52S–6S.

    PubMed  CAS  Google Scholar 

  8. Marsden CD, MRHS, Baldessarini RJ. Extrapyramidal movement disorders produced by antipsychotic drugs. In: Hirsch SR, Bradley PB, editors. Pharmacology and Treatment of Schizophrenia. London: Oxford; 1986.

  9. Woerner MG, et al. Diabetes and development of tardive dyskinesia. Am J Psychiatry. 1993;150(6):966–8.

    PubMed  CAS  Google Scholar 

  10. Yassa R, Jeste DV. Gender differences in tardive dyskinesia: a critical review of the literature. Schizophr Bull. 1992;18(4):701–15.

    PubMed  CAS  Google Scholar 

  11. FitzGerald PM, Jankovic J. Tardive oculogyric crises. Neurology. 1989;39(11):1434–7.

    PubMed  CAS  Google Scholar 

  12. Fahn S, Jankovic J. Principles and practice of movement disorders. Philadelphia: Churchill Livingstone; 2007.

    Google Scholar 

  13. Lang AE. Clinical differences between metoclopramide- and antipsychotic-induced tardive dyskinesias. Can J Neurol Sci. 1990;17(2):137–9.

    PubMed  CAS  Google Scholar 

  14. Samie MR, Dannenhoffer MA, Rozek S. Life-threatening tardive dyskinesia caused by metoclopramide. Mov Disord. 1987;2(2):125–9.

    Article  PubMed  CAS  Google Scholar 

  15. Horiguchi J, et al. Antipsychotic-induced life-threatening ‘esophageal dyskinesia’. Int Clin Psychopharmacol. 1999;14(2):123–7.

    Article  PubMed  CAS  Google Scholar 

  16. Labbate LA, et al. Tardive dyskinesia in older out-patients: a follow-up study. Acta Psychiatr Scand. 1997;96(3):195–8.

    Article  PubMed  CAS  Google Scholar 

  17. • Fasano A, Bentivoglio AR. Tetrabenazine. Expert Opin Pharmacother. 2009;10(17):2883–96.

    Article  PubMed  CAS  Google Scholar 

  18. Huntington Study Group. Tetrabenazine as antichorea therapy in Huntington disease: a randomized controlled trial. Neurology. 2006;66(3):366–72.

    Article  Google Scholar 

  19. Ondo WG, Hanna PA, Jankovic J. Tetrabenazine treatment for tardive dyskinesia: assessment by randomized videotape protocol. Am J Psychiatry. 1999;156(8):1279–81.

    PubMed  CAS  Google Scholar 

  20. Kenney C, Hunter C, Jankovic J. Long-term tolerability of tetrabenazine in the treatment of hyperkinetic movement disorders. Mov Disord. 2007;22(2):193–7.

    Article  PubMed  Google Scholar 

  21. Huang CC, et al. Evaluation of reserpine and alpha-methyldopa in the treatment of tardive dyskinesia. Psychopharmacol Bull. 1980;16(3):41–3.

    PubMed  CAS  Google Scholar 

  22. Huang CC, et al. Reserpine and alpha-methyldopa in the treatment of tardive dyskinesia. Psychopharmacol Berl. 1981;73(4):359–62.

    Article  CAS  Google Scholar 

  23. Fahn S. A therapeutic approach to tardive dyskinesia. J Clin Psychiatry. 1985;46(4 Pt 2):19–24.

    PubMed  CAS  Google Scholar 

  24. Lieberman JA, et al. The effects of clozapine on tardive dyskinesia. Br J Psychiatry. 1991;158:503–10.

    Article  PubMed  CAS  Google Scholar 

  25. Bacher NA, Lewis HA. Propranolol, anxiety, and tardive dyskinesia. J Clin Psychiatry. 1983;44(5):196.

    PubMed  CAS  Google Scholar 

  26. Perenyi A, Farkas A. Propranolol in the treatment of tardive-dyskinesia. Biol Psychiatry. 1983;18(3):391–4.

    PubMed  CAS  Google Scholar 

  27. Pitts FN. Treatment of tardive-dyskinesia with propranolol. J Clin Psychiatry. 1982;43(8):304–4.

    PubMed  Google Scholar 

  28. Schrodt GR, et al. Treatment of tardive-dyskinesia with propranolol. J Clin Psychiatry. 1982;43(8):328–31.

    PubMed  Google Scholar 

  29. Soares KV, McGrath JJ. Vitamin E for neuroleptic-induced tardive dyskinesia. Cochrane Database Syst Rev. 2000;(2):CD000209.

  30. Adler LA, et al. Vitamin E treatment of tardive dyskinesia. Am J Psychiatry. 1993;150(9):1405–7.

    PubMed  CAS  Google Scholar 

  31. Adler LA, et al. Vitamin E treatment for tardive dyskinesia. Veterans Affairs Cooperative Study #394 Study Group. Arch Gen Psychiatry. 1999;56(9):836–41.

    Article  PubMed  CAS  Google Scholar 

  32. Thaker GK, et al. Clonazepam treatment of tardive dyskinesia: a practical GABAmimetic strategy. Am J Psychiatry. 1990;147(4):445–51.

    PubMed  CAS  Google Scholar 

  33. Bobruff A, et al. Clonazepam and phenobarbital in tardive dyskinesia. Am J Psychiatry. 1981;138(2):189–93.

    PubMed  CAS  Google Scholar 

  34. • Pappa S, et al. Effects of amantadine on tardive dyskinesia: a randomized, double-blind, placebo-controlled study. Clin Neuropharmacol. 2010;33(6):271–5.

    Article  PubMed  CAS  Google Scholar 

  35. Angus S, et al. A controlled trial of amantadine hydrochloride and neuroleptics in the treatment of tardive dyskinesia. J Clin Psychopharmacol. 1997;17(2):88–91.

    Article  PubMed  CAS  Google Scholar 

  36. Woods SW, et al. Effects of levetiracetam on tardive dyskinesia: a randomized, double-blind, placebo-controlled study. J Clin Psychiatry. 2008;69(4):546–54.

    Article  PubMed  CAS  Google Scholar 

  37. Slotema CW, et al. Botulinum toxin in the treatment of orofacial tardive dyskinesia: a single blind study. Prog Neuropsychopharmacol Biol Psychiatry. 2008;32(2):507–9.

    Article  PubMed  CAS  Google Scholar 

  38. Esper CD, Freeman A, Factor SA. Lingual protrusion dystonia: frequency, etiology and botulinum toxin therapy. Parkinsonism Relat Disord. 2010;16(7):438–41.

    Article  PubMed  Google Scholar 

  39. Hennings JM, Bötzel KE, Wetter TC. Successful treatment of tardive lingual dystonia with botulinum toxin: case report and review of the literature. Prog Neuropsychopharmacol Biol Psychiatry. 2008;32(5):1167–71.

    Article  PubMed  CAS  Google Scholar 

  40. Welter ML, Grabli D, Vidailhet M. Deep brain stimulation for hyperkinetics disorders: dystonia, tardive dyskinesia, and tics. Curr Opin Neurol. 2010;23(4):420–5.

    PubMed  Google Scholar 

Download references

Disclosure

Conflicts of Interest: P. Aia: none; G. Revuelta: none; L. Cloud: Participant in scientific advisory board for UCB Pharma; S. Factor: Expert testimony on behalf of Boehringer Ingelheim.

Author information

Authors and Affiliations

  1. Department of Neurology, Emory University School of Medicine, 1841 Clifton Road, Atlanta, GA, 30329, USA

    Pratibha G. Aia MD, Leslie J. Cloud MD & Stewart A. Factor DO

  2. Department of Neurology, Medical University of South Carolina, 326 Calhoun Street, Suite 308 / MSC 108, Charleston, SC, 29401, USA

    Gonzalo J. Revuelta DO

Authors
  1. Pratibha G. Aia MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gonzalo J. Revuelta DO
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Leslie J. Cloud MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stewart A. Factor DO
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pratibha G. Aia MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Aia, P.G., Revuelta, G.J., Cloud, L.J. et al. Tardive Dyskinesia. Curr Treat Options Neurol 13, 231–241 (2011). https://doi.org/10.1007/s11940-011-0117-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11940-011-0117-x

Keywords

Search

Navigation