Summary about Disease
Tardive dyskinesia (TD) is a neurological syndrome characterized by repetitive, involuntary movements, most often affecting the face, mouth, tongue, and jaw. It can also affect the limbs, torso, and, less commonly, the diaphragm and other muscles involved in breathing. It is most commonly a side effect of long-term use of certain medications, particularly antipsychotics used to treat mental health conditions. The movements can range from mild and barely noticeable to severe and disabling.
Symptoms
The primary symptom is involuntary, repetitive movements. These can include:
Facial movements: Lip smacking, chewing motions, tongue protrusion, grimacing, blinking, puffing of cheeks.
Limb movements: Jerky or writhing movements of the arms, legs, fingers, or toes.
Trunk movements: Rocking, swaying, or twisting of the torso.
Other movements: Frowning, shoulder shrugging, pelvic thrusting, difficulty breathing (rare but possible). The severity of symptoms can vary widely.
Causes
The most common cause of TD is the long-term use of dopamine receptor-blocking agents (DRBAs). These drugs are primarily antipsychotics, but can also include some medications used to treat gastrointestinal disorders (e.g., metoclopramide). These medications block dopamine receptors in the brain, and the dyskinesia is thought to result from the brain's adaptation to this blockage, leading to dopamine receptor supersensitivity. Other less common causes are certain other medication and rare neurological conditions.
Is Communicable
No, tardive dyskinesia is not a communicable disease. It is a drug-induced syndrome or, in rare cases, linked to underlying conditions, not an infection.
Precautions
Informed consent: Patients starting dopamine receptor-blocking agents should be fully informed about the risk of TD.
Lowest effective dose: Use the lowest effective dose of dopamine receptor-blocking agents for the shortest duration necessary.
Regular monitoring: Patients on these medications should be regularly monitored for early signs of TD.
Alternative treatments: Consider alternative treatments that do not carry the same risk of TD, if possible.
Early detection: Early detection and intervention may improve the chances of reversing TD.
How long does an outbreak last?
Tardive dyskinesia is not an "outbreak" in the sense of an infectious disease. Once developed, TD can be persistent and may last for years, even after the offending medication is discontinued. In some cases, symptoms may be irreversible. For some patients the symptoms may decrease over time after stopping the medication.
How is it diagnosed?
Diagnosis is based on:
Clinical Examination: Observation of characteristic involuntary movements.
Medication History: A history of exposure to dopamine receptor-blocking agents.
Ruling out other conditions: Excluding other conditions that can cause similar movements, such as Huntington's disease, Wilson's disease, or other drug-induced movement disorders.
Abnormal Involuntary Movement Scale (AIMS): A standardized rating scale used to assess the severity of involuntary movements.
Timeline of Symptoms
9. Timeline of symptoms The onset of TD can vary widely:
Early onset: Symptoms may appear within weeks or months of starting the offending medication.
Delayed onset: Symptoms may not appear until after years of medication use, or even after the medication has been discontinued.
Worsening on withdrawal: In some cases, symptoms may worsen temporarily when the medication is reduced or stopped (withdrawal dyskinesia). The course of TD is also variable, with some individuals experiencing gradual improvement over time, while others have persistent or worsening symptoms.
Important Considerations
Quality of life: TD can significantly impact quality of life, affecting social interactions, self-esteem, and physical functioning.
Differential Diagnosis: It's crucial to distinguish TD from other movement disorders.
Treatment Limitations: Treatment options are limited, and management often involves balancing the benefits of medication against the risk of side effects.
Patient education and support: Providing patients and their families with education and support is essential for coping with TD.
Consultation with specialists: It is important to consult with a neurologist or psychiatrist with expertise in movement disorders for diagnosis and management.