Tardive dyskinesia (TD) is a movement disorder characterized by repetitive, involuntary movements, often affecting the face, mouth, tongue, and limbs. These movements are often uncontrollable and can significantly impact a person's quality of life.
Understanding Tardive Dyskinesia
TD typically develops as a side effect of long-term use of certain medications, particularly antipsychotics used to treat mental health conditions like schizophrenia and bipolar disorder. While less common, other medications such as those used for gastrointestinal disorders can also contribute to TD.
Symptoms of Tardive Dyskinesia
The symptoms of TD vary but often include:
- Facial movements: Lip smacking, chewing motions, tongue thrusting, grimacing, and blinking.
- Limb movements: Jerky or writhing movements of the arms, legs, fingers, and toes.
- Trunk movements: Rocking, pelvic thrusting, or twisting motions.
The severity of these symptoms can range from mild and barely noticeable to severe and disabling.
Causes and Risk Factors
- Antipsychotic Medications: First-generation ("typical") and second-generation ("atypical") antipsychotics are the most common cause.
- Other Medications: Certain antiemetics (drugs for nausea and vomiting) and metoclopramide can also increase the risk.
- Duration of Treatment: The longer a person takes these medications, the higher the risk of developing TD.
- Age: Older adults are more susceptible.
- Sex: Women are more likely to develop TD than men.
- Pre-existing Conditions: Individuals with mood disorders may be at increased risk.
Diagnosis and Treatment
Diagnosis typically involves a physical examination and a review of the patient's medication history. Standardized rating scales, such as the Abnormal Involuntary Movement Scale (AIMS), help assess the severity of the movements.
Treatment options include:
- Discontinuation or Reduction of Offending Medications: If possible, discontinuing or reducing the dose of the medication causing TD is the first step. However, this must be done carefully under medical supervision.
- Valbenazine and Deutetrabenazine: These are VMAT2 inhibitors specifically approved for the treatment of TD. They help reduce the involuntary movements.
- Other Medications: In some cases, medications like tetrabenazine or clonazepam may be used to manage symptoms. However, these are often less effective than VMAT2 inhibitors and can have their own side effects.
- Botulinum Toxin Injections: For localized symptoms, botulinum toxin (Botox) injections can help reduce muscle spasms.
Prevention
While TD cannot always be prevented, strategies to minimize the risk include:
- Using the lowest effective dose of antipsychotics.
- Regular monitoring for early signs of TD.
- Considering alternative treatments when appropriate.
