Tardive dyskinesia

Clinical Features

• Orofacial involuntary movements
  • Described as grimacing, writhing and choreathetoid
  • Grimacing, tongue movements, lip smacking, excessive eye blinking
• Often occurs after years of treatment with neuroleptic agents
• Risk factors:
  • Longer duration of neuroleptic treatment
  • Concomitant mood disorder
  • Patient age, particularly elderly females

Evaluation

• Clinical diagnosis

Differential Diagnosis

• See DDX for chorea

Management

• Mild symptoms: cessation of the neuroleptic drug or decreasing the dose, which rarely reverses symptoms
• Moderate to severe symptoms: reserpine and tetrabenazine
• New drug approved 2017
  • Austedo (deutetrabenazine), previously approved for chorea due to Huntington's disease
  • 12-48 mg/day PO divided BID, starting at 6 mg BID, increased by 6 mg/day qwk

See Also

• Seizure

References

• Hockberger RS, Richards JR: Thought Disorders; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, (Ch) 110: p 1460-1466