Tardive dyskinesia (TD) is a neurologic syndrome. It results from using neuroleptic drugs—also called antipsychotic drugs. This class of drugs is used to treat psychiatric conditions, like
. TD consists of a group of symptoms including:
Abnormal twisting movementsAbnormal postures due to sustained muscle contractions
It is unclear exactly why TD develops. Long-term use of neuroleptic drugs can cause changes in the chemistry in the brain that lead to the symptoms. Nerve cells may also become overly sensitive to certain substances. Not everyone who takes these drugs develops TD.
TD is more common in women and in people over the age of 54. Other factors that may increase your risk of TD include:
Use of neuroleptic drugs, especially if the drugs:
Are taken in high doses for longer than 6 monthsAre first generation drugs, which are the first drugs developed to treat a condition
and prochlorperazine—These medications are used to treat gastrointestinal problems, like nausea, vomiting, delayed bowel emptying, and
gastroesophageal reflux disease
(GERD), especially if taken more than 3 months
Possible genetic factor
Having a disease that may require using neuroleptic drugs, such as:
or other psychiatric disorders
Behavior problems that occur with psychiatric or neurologic disorders, such as agitation in
Alzheimer’s diseaseDigestive disorders
TD causes repetitive movements. Movements usually occur in the face, mouth, limbs, or trunk. The movements are involuntary and serve no purpose. They may occur occasionally or all of the time. They may or may not be noticeable. Symptoms may begin while on the drug or within weeks of stopping it.
Symptoms may include: GrimacingSticking out the tongueTwisting the tongueChewingSuckingSmacking lipsPuckering lipsBlinking eyesFacial ticsFoot tappingMoving fingers as if playing the pianoRapidly moving arms, legs, or bodyWrithing movementsPelvic thrustsGruntingSighingNoisy breathing
They can worsen with: StressMoving other parts of the bodyTaking certain drugs
Symptoms may decrease with: RelaxationSleepPurposely moving the affected body part
The doctor will ask about your symptoms and medical history. A physical exam will be done. Other disorders can cause symptoms similar to those of TD. The doctor will rule out other disorders before making a diagnosis. There is no specific test for TD.
to rule out other disorders
may include: Blood tests
Imaging tests can evaluate the brain and surrounding structures. They may include:
CT scanMRI scan
CT Scan of the Head
Copyright © Nucleus Medical Media, Inc.
To treat TD, your doctor may: Stop the neuroleptic medicationLower the doseSwitch you to a different medication
vitamin E, which may reduce the risk of worsening symptoms
Symptoms may decrease over time even if you continue to take the neuroleptic drug. Younger people tend to do better.
Some medications may help decrease symptoms, such as: TrihexyphenidylReserpinePropranololClonidineBaclofen
Antipsychotic drugs that may help with movement disordersMelatoninDiphenhydramine
Deep Brain Stimulation (DBS) is being evaluated for the treatment of TD.
If you need neuroleptic drugs to control a psychiatric disorder, consider these guidelines to help prevent TD:
Talk with your doctor about:
Risks and benefits of the medicationWhether the dose is right for you and how well the drug is workingOther medications you can try that have less risk of TDWhether you can take a drug holiday to take a break from using the medicationEven a small symptom of TD that you have—early treatment works bestDo not stop taking your medication without first talking to your doctor. If you stop the drug right away, it may trigger TD.See your doctor on a regular basis as advised.
Bai YM, Yu SC, Lin CC.
Risperidone for severe tardive dyskinesia: A 12-week randomized, double-blind, placebo-controlled study.
J Clin Psychiatry. 2003;64(11):1342-1348.
Damier P. Drug-induced dyskinesias.
Curr Opin Neurol. 2009;22(4):394-399.
Kinon BJ, Jeste DV, Kollack-Walker S, Stauffer V, Liu-Seifert H.
Olanzapine treatment for tardive dyskinesia in schizophrenia patients: a prospective clinical trial with patients randomized to blinded dose reduction periods.
Prog Neuropsychopharmacol Biol Psychiatry. 2004;28(6):985-996.
McGrath JJ, Soares KV. Neuroleptic reduction and/or cessation and neuroleptics as specific treatments for tardive dyskinesia.
Database Syst Rev. 2006;(1):CD000459.
Meco G, Fabrizio E, Epifanio A, Morgante F, et al. Levetiracetam in tardive dyskinesia.
Clin Neuropharmacol. 2006;29(5):265-268.
Pham DQ, Plakogiannis R. Vitamin E supplementation in Alzheimer’s disease, Parkinson’s disease, tardive dyskinesia, and cataract: Part 2.
Ann Pharmacother. 2005;39(12):2065-2072.
Sachdev PS. The current status of tardive dyskinesia.
Australian and New Zealand Journal of Psychiatry. 2000;34(3):355-369.
Soares KV, McGrath JJ. The treatment of tardive dyskinesia: A systematic review and meta-analysis.
Tardive dyskinesia. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed. Updated November 23, 2011. Accessed July 29, 2013.
Thema B, Srivastava V, Tiwari AK. Genetic underpinnings of tardive dyskinesias: passing the baton to pharmacogenetics.
Last reviewed June 2015 by Rimas Lukas, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © EBSCO Publishing. All rights reserved.