Tardive Dyskinesia: Causes, Symptoms & Treatment

Tardive dyskinesia is dystonia that can occur as a result of years or decades of neuroleptic administration and takes the form of a movement disorder. Patients often grimace or suffer from impaired breathing or bowel movement. After the manifestation of tardive dyskinesia, the condition is difficult to treat.

What is tardive dyskinesia?

Dystonia is a neurogenic movement disorder that originates in motor brain centers and is classified as extrapyramidal hyperkinesia. Most often, dystonia manifests itself in spasms or abnormal postures. In medicine, different forms of dystonia are distinguished. One of them is tardive dyskinesia, that is, delayed motor dysfunction, also known as tardive dyskinesia or dyskinesia tarda. Such movement disorders often affect the facial region, in which case they manifest as twitching, smacking or chewing movements, grimacing, or other involuntary combinations of movements. In addition to the face, the extremities can also be affected, in which case the condition is referred to as hyperkinesis. Two different types of tardive dyskinesia are known to medicine. This form can be accompanied by severe paralysis and mainly affects young people. The clinical picture is also called drug-induced dystonia because it is often associated with neuroleptics.

Causes

Tardive dyskinesia occurs primarily with the use of older neuroleptics of the butyrophenone or phenothiazine type. Only clozapine does not appear to be associated with tardive dyskinesia. Olanzapine, however, may cause extrapyramidal movement disorders in a few patients. A frequency of 15 percent applies to conventionally highly potent neuroleptics. Additional risk factors for movement disorder include smoking, brain injury, and older age. The side effects of neuoleptics can occur because the neuroleptic messengers are also found in other nervous system areas. Dopaminergic excitatory transmission is disrupted by neuroleptic-induced receptor blockade in the basal ganglia. This mechanism of action is thought to be the cause of tardive dyskinesia. Tardive dyskinesias are extrapyramidal hyperkinesias and generally only occur after long-term therapy with the aforementioned psychotropic drugs. Exactly when des becomes manifest varies from case to case.

Symptoms, complaints, and signs

Tardive orobuccolingual dyskinesia is associated with tics. Patients with this type of tardive dyskinesia grimace rhythmically in the facial area, such as with the entire face, tongue, or mouth. Disturbances of respiration and bowel movement have occurred in very few isolated cases. The same applies to rhythmic movements such as pelvic dyskinesia and continuous movements of the hands. Predominantly younger people often suffer from tardive dyskinesia with considerable impairment or the complete loss of bodily functions. Paralysis symptoms are also conceivable in this context. Particularly characteristic of tardive dyskinesia are repeated involuntary or purposeless movements such as curling or pursing of the lips or conspicuously rapid blinking movements. Less commonly, involuntary movements are seen in the extremities. Blepharospasm is also a rather rare symptom.

Diagnosis and course of the disease

The diagnosis of tardive dyskinesia is made by the neurologist. In addition to visual diagnosis and history, imaging of the skull plays a role in the diagnostic process. The prognosis of patients is relatively unfavorable. Most tardive kinesias are irreversible and have little response to medication.

Complications

In the setting of tardive dyskinesia, affected individuals suffer from various complications. Typical are tics, which take the form of facial twitching, rapid blinking, respiratory disturbances, and unusual bowel movements. Compulsive movements may also occur in the back and hands, eventually leading to a complete loss of bodily functions. Rarely, eyelid spasms occur, accompanied by muscle pain, headaches and tension. Sufferers suffer physically from these obsessive-compulsive disorders, as regular tics are accompanied by a range of symptoms. However, the greatest complications are psychological. Thus, the characteristic appearance of tardive dyskinesia almost always results in inferiority complexes or depression.Those affected often withdraw from social life or are ostracized. This additionally increases the pressure of suffering and considerably restricts the quality of life. Although treatment is possible, it also carries risks. For example, the drug botulinum toxin, which is typically prescribed, is injected by the doctor into the muscle affected by dyskinesia in order to achieve relaxation. For example, for disorders of the eye, restrictions of facial expressions, dry mouth and eyelid spasms. Other medicines should therefore always be taken under the supervision of a physician.

When should you see a doctor?

The person affected by tardive dyskinesia is in any case dependent on treatment and examination by a physician. As a rule, this is the only way to achieve a complete cure, since the condition cannot usually be treated by self-help measures, nor can self-healing occur. A doctor should always be consulted for tardive dyskinesia if the affected person suffers from severe symptoms. In most cases, patients feel permanently tired and weary and can no longer actively participate in their daily lives. Even difficult and strenuous activities can no longer be performed without difficulty, so that the affected person’s everyday life is also severely restricted by tardive dyskinesia. If these symptoms occur and do not disappear on their own, a doctor should be consulted in any case. Involuntary movements or paralysis in various parts of the body can also indicate tardive dyskinesia. Tardive dyskinesia can be diagnosed and treated by a general practitioner or by a neurologist. Whether this will result in a cure cannot be universally predicted.

Treatment and therapy

The only causative therapy for patients with tardive dyskinesia is timely discontinuation of medication. In many cases, however, this approach is impractical because the problems are recognized too late. As soon as tardive dyskinesia becomes manifest, patients usually respond poorly to treatment attempts, as the influence is already irreversible even at the onset of symptoms. Medicinal conservative therapy options exist, for example, with dopamine agonistic agents as used in Parkinson’s disease. In addition to lisuride and pergolide, movement-normalizing substances such as tiapride or tizanidine are used. Physiotherapy may play a role in alleviating the subjectively distressing symptoms. However, involuntary movements usually elude voluntary control, making physiotherapy extremely difficult and lengthy. As tardive dyskinesia affects social life to a greater or lesser degree, psychological complaints may set in. Psychotherapy is indicated for already manifest complaints of the psyche. In it, the patient learns to cope better with the reactions to his movement disorder. In the recent past, drug therapy has sometimes used botulinum toxin, which in some cases has been able to bring about at least a temporary improvement in the symptoms. However, all medicamentous treatment steps are to be understood as purely symptomatic therapy. Furthermore, the additional drug administrations are associated with again other side effects, so that a vicious circle occurs. Thus, because tardive dyskinesia is difficult to treat after manifestation, prophylaxis and risk minimization is one of the most important steps.

Prevention

Pharmacologically, the newer atypical neuroleptics have marked differences from older preparations. Tardive dyskinesia appears to be less common with the newer variants. On the other hand, there are significantly fewer long-term studies on the newer substances, so that the risk of dyskinesia cannot ultimately be adequately assessed for many of the new developments. Each administration of a highly potent typical neuroleptic increases the individual risk of tardive dyskinesia. In this context, there seems to be at least little to lose by the alternative use of newer and atypical agents. Because nicotine use also appears to increase risk, abstaining from nicotine use may be considered another preventive measure.

Follow-up

In most cases, very few options for direct follow-up are available to the affected person with tardive dyskinesia.For this reason, the affected person should consult a doctor as early as possible in the case of this disease and also initiate treatment, so that complications or other complaints do not arise in the further course. As a rule, self-healing cannot occur, so that the affected person should first consult a doctor. In some cases, the symptoms themselves can be well alleviated with the help of various medications. The affected person should always ensure that the medication is taken regularly and in the correct dosage so that the symptoms can be alleviated properly and, above all, permanently. If anything is unclear, a doctor should be contacted so that complications do not arise in the further course. Help and support from one’s own family also has a very positive effect on the further course of this disease, which can also prevent depression and other psychological upsets. In some cases, tardive dyskinesia also reduces the life expectancy of the affected person.

Here’s what you can do yourself

Self-help measures can usually not make a visit to the doctor unnecessary, because for certain conditions, self-treatment carries an incalculable risk. Tardive dyskinesia is different: it defies any form of treatment. Patients have to cope with the twitching and involuntary movements in everyday life. Even physiotherapy is not able to stop them. Tardive dyskinesia is a psychological burden for those affected. An undisturbed communication is hardly possible due to the uninfluenceable facial movements. Other people perceive the body signals sent incorrectly. It is not uncommon for the disease to lead to social isolation. There is no effective remedy for this. Even trained therapists are usually unable to treat such complaints successfully. Only explanations to the interlocutor create clarity and allow a less troublesome communication. The impossibility of self-treatment in tardive dyskinesia extends not only to facial expressions. Twitching of the arms and legs is just as possible. They occur uncontrollably, are not controllable, and thus are not amenable to self-treatment. Some scientists recommend the cessation of nicotine consumption. However, the extent to which this leads to a reduction in the unreal movements has not been conclusively clarified.