Tardive dyskinesia

Tardive dyskinesia
Other names	Linguofacial dyskinesia, tardive dystonia, tardive oral dyskinesia[1]
Tardive dyskinesia is believed to involve the neurotransmitter dopamine.
Pronunciation	/ˈtɑːrdɪv ˌdɪskɪˈniːʒə/, /tɑːrdaɪv/ /ˌdɪskəˈniːʒə/
Specialty	Neurology, psychiatry
Symptoms	Involuntary, repetitive body movements[1]
Causes	Neuroleptic medications (antipsychotics), metoclopramide[1][2]
Diagnostic method	Based on symptoms after ruling out other potential causes[1]
Differential diagnosis	Huntington's disease, cerebral palsy, Tourette syndrome, dystonia[2]
Prevention	Using lowest possible dose of neuroleptic medication[3]
Treatment	Stopping neuroleptic medication if possible, switching to clozapine[1]
Medication	Valbenazine, tetrabenazine, botulinum toxin[1][4]
Prognosis	Variable[1]
Frequency	20% (atypical antipsychotics) 30% (typical antipsychotics)[5]

Tardive dyskinesia (TD) is an iatrogenic disorder that results in involuntary repetitive body movements, which may include grimacing, sticking out the tongue or smacking the lips,^[1] which occurs following treatment with medication.^[6][7] Additional motor symptoms include chorea or athetosis.^[1] In about 20% of people with TD, the disorder interferes with daily functioning.^[3] If TD is present in the setting of a long-term drug therapy, reversibility can be determined primarily by severity of symptoms and how long symptoms have been present before the long-term drug has been stopped.

Tardive dyskinesia occurs as a result of long-term use of dopamine-receptor-blocking medications such as antipsychotics and metoclopramide.^[1][2] These medications are usually used for mental illness but may also be given for gastrointestinal or neurological problems.^[1] The condition typically develops only after months to years of use.^[1][3] The diagnosis is based on the symptoms after ruling out other potential causes.^[1]

Efforts to prevent the condition include either using the lowest possible dose or discontinuing use of neuroleptics.^[3] Treatment includes stopping the neuroleptic medication if possible (although this may temporarily worsen symptoms) or switching to clozapine.^[1] Other medications such as valbenazine, tetrabenazine, or botulinum toxin may be used to lessen the symptoms.^[1][4] With treatment, some see a resolution of symptoms, while others do not.^[1]

Rates in those on atypical antipsychotics are about 20%, while those on typical antipsychotics have rates of about 30%.^[5] The risk of acquiring the condition is greater in older people,^[3] for women, as well as patients with mood disorders and/or medical diagnoses receiving antipsychotic medications.^[8] The term "tardive dyskinesia" first came into use in 1964.^[3]