Tardive dyskinesia

Tardive dyskinesia (TD) is a neurologic disorder that typically presents with repetitive, involuntary movements, emerging in the context of long-term use of dopamine receptor-blocking drugs.

Diagnosis is clinical, based on a history of exposure to dopamine receptor-blocking drugs (e.g., antipsychotics, metoclopramide), clinical observation of characteristic involuntary movements, and an absence of other conditions that might cause the signs and symptoms.

Consider the severity of the TD symptoms and of any underlying psychiatric disorder when deciding on a treatment approach. Some patients may be able to stop the causative drug without the risk of worsening their mental health condition, whereas for others (e.g., those with schizophrenia), stopping therapy may lead to risk of relapse.

Vesicular monoamine transporter type 2 (VMAT2) inhibitors, benzodiazepines, amantadine, botulinum toxin, and deep brain stimulation may be considered as treatment options.

TD is a hyperkinetic movement disorder, characterized by repetitive, involuntary choreiform, athetoid, or semirhythmic movements, typically of the oral, buccal, and lingual regions and less commonly of the lower extremities, lasting at least 4 weeks and emerging in the context of long-term use (at least 3 months, or at least 1 month in people ages >60 years) of dopamine receptor-blocking drugs (also known as dopamine antagonists), typically antipsychotics.[1]Savitt D, Jankovic J. Tardive syndromes. J Neurol Sci. 2018 Jun 15;389:35-42. http://www.ncbi.nlm.nih.gov/pubmed/29506749?tool=bestpractice.com [2]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022. https://www.psychiatry.org/psychiatrists/practice/dsm ​ In French, the term "tardive" implies something that develops late, in this case reflecting the fact that onset of signs and symptoms follows prolonged use of the causative drug.

The term extrapyramidal syndrome, although still used in some of the literature, should not be used as it does not convey the specific phenomenology observed in drug-induced movement disorders such as TD. Tardive syndrome is an umbrella term that encompasses several tardive phenomena such as tardive stereotypy, tardive akathisia, tardive dystonia, tardive myoclonus, tardive tremor, and tardive parkinsonism.[1]Savitt D, Jankovic J. Tardive syndromes. J Neurol Sci. 2018 Jun 15;389:35-42. http://www.ncbi.nlm.nih.gov/pubmed/29506749?tool=bestpractice.com [3]Friedman JH. Tardive syndromes. Continuum (Minneap Minn). 2019 Aug;25(4):1081-98. http://www.ncbi.nlm.nih.gov/pubmed/31356294?tool=bestpractice.com