Rare Classroom: Tardive Dyskinesia

Welcome to the Rare Classroom, a new series from Patient Worthy. Rare Classroom is designed for the curious reader who wants to get informed on some of the rarest, most mysterious diseases and conditions. There are thousands of rare diseases out there, but only a very small number of them have viable treatments and regularly make the news. This series is an opportunity to learn the basics about some of the diseases that almost no one hears much about or that we otherwise haven’t been able to report on very often.

Eyes front and ears open. Class is now in session.

The rare disease that we will be learning about today is:

Tardive Dyskinesia

Sometimes called tardive dystonia.

What is Tardive Dyskinesia?

  • Tardive dyskinesia is a disorder which is characterized by involuntary movements. These movements are often repetitive and can impact several different parts of the body.
  • In around 20 percent of cases, the disorder is severe enough to impact daily functions.
  • Tardive dyskinesia is often misdiagnosed as a mental illness
  • The disease was first described in the 1950s
  • Patients are at risk of social isolation because of the unusual symptoms and face an increased risk of mental health disorders

How Do You Get It?

  • A decisive cause of tardive dyskinesia is long-term use of metoclopramide (used to treat esophageal or stomach problems) and antipsychotic drugs such as chlropromazine
    • These drugs share a common mechanism which blocks dopamine receptors
    • Symptoms typically develop after months or years of regular use
  • A range of risk factors have been identified for the development of tardive dyskinesia, such as:
    • Old age
    • Racial background, with people of African or Asian origin being at higher risk
    • Neurological side effects from antipsychotic drugs
    • Diabetes
    • Brain injuries
    • Gender, with women being at greater risk
    • Mood disorders

What Are the Symptoms?

  • The principal symptoms of tardive dyskinesia are involuntary movements. Examples can include:
    • Pursing the lips
    • Grimacing
    • Tongue movement
    • Lip puckering or smacking
    • Excessive blinking
    • Sudden movements of the torso, fingers, and limbs
  • The legs can be impacted to an extent that walking ability is impaired.
  • A small number of patients may experience grunting and breathing difficulty
  • Some patients are literally unable to sit still

How Is It Treated?

  • Tardive dyskinesia can often be presented by using the lowest effective dose of the neuroleptic drug for the shortest possible period of time; however, this must be balanced against considerations regarding the condition that the neuroleptic is meant to treat.
    • If a diagnosis is made, then the causative drug must be discontinued
    • Atypical antipsychotics are recommended over typical antipsychotics as the risk of developing tardive dyskinesia is slightly lower
  • Unfortunately, symptoms may persist for months or years after cessation, and are even permanent in some cases
  • Some studies have suggested that supplementing antipsychotics with vitamin E, melatonin, or antioxidants can reduce the risk
  • The FDA approved tetrabenazine and deutetrabenazine in 2017 for the treatment of tardive dyskinesia
    • Tetrabenazine can also be used
    • Clonidine is another treatment option, but is limited by the side effects of sedation and hypotension, which limits the dose
    • Vitamin B6 may also be beneficial
  • Treatment outcomes are variable; while some see their symptoms resolve with proper treatment, others do not

Where Can I Learn More???

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