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What is tardive dyskinesia?

Tardive dyskinesia (TD) is a rare disease characterised by involuntary movements of the muscles of the body due to antipsychotic drugs used for treating depression, schizophrenia and other mental disorders. Muscles affected are those of the face, upper limb and, sometimes, the lower limb. Once TD develops, it may be permanent, but its intensity can be reduced by switching over to other milder forms of antipsychotic drugs.

What are its main signs and symptoms?

TD usually results in the development of jerky movements along with stiffness of the affected muscles. Other symptoms include:

  • Sticking of the tongue to the roof of the mouth
  • Rapid blinking of eyes
  • Smacking or puckering of lips
  • Frowning
  • Tongue thrusting
  • Puffing of cheeks
  • Piano-playing movements (finger movements)
  • Tapping of feet
  • Wiggling of fingers
  • Swaying sideways

What are the main causes?

In our brain, a neurotransmitter called dopamine is released for the communication between nerve cells. When the dopamine levels in the cells reduce, it results in the jerky movements of the arms. Usually, medicines used for the treatment of schizophrenia, psychoses, bipolar disorders and such other conditions can reduce the dopamine levels in the brain. Use of these anti-psychotics for over 3 months can result in the increase of dopamine sensitivity and cause TD.

How is it diagnosed and treated?

It is relatively difficult to diagnose TD as its symptoms start gradually or at times even after stopping the medicine. Regular check-ups and physical examination, while on anti-psychotics, can help identify these symptoms earlier. Certain blood investigations like the evaluation of vitamin B12 levels, homocysteine levels etc. along with CT and MRI scan can rule out other diseases that cause such jerky movements.

Usually, once the symptoms of TD develop, it is difficult to reverse it or stop these involuntary movements. However, if detected early, stopping the antipsychotics or reducing their dosage may help in reducing the severity of the symptoms. Two FDA-approved dugs for this are valbenazine and deutetrabenazine, which can help in maintaining dopamine levels in the brain and in reducing the movements. In severe cases, deep brain stimulation (DBS) may be tried to control the movements.

 

  1. Medicines for Tardive Dyskinesia

References

  1. National Organization for Rare Disorders [Internet], Tardive Dyskinesia
  2. MedlinePlus Medical Encyclopedia: US National Library of Medicine; Tardive dyskinesia
  3. Elyse M. Cornett et al. Medication-Induced Tardive Dyskinesia: A Review and Update . Ochsner J. 2017 Summer; 17(2): 162–174. PMID: 28638290
  4. National Institute of Neurological Disorders and Stroke [Internet] Maryland, United States; Tardive Dyskinesia Information Page.
  5. Vasan S, Padhy RK. Tardive Dyskinesia. [Updated 2019 Feb 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.
  6. U. S Food and Drug Association. [Internet]. FDA approves first drug to treat tardive dyskinesia
  7. Olga Waln, Joseph Jankovic. An Update on Tardive Dyskinesia: From Phenomenology to Treatment . Tremor Other Hyperkinet Mov (N Y). 2013; 3: tre-03-161-4138-1. PMID: 23858394
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