What Is Tardive Dyskinesia?

What is Tardive Dyskinesia? H. A. Jinnah, MD, PhD Associate Professor of Neurology Johns Hopkins University

Tardive Dyskinesia “Late” or “Delayed”

“Abnormal movement”

Tardive Dyskinesia Manifestations • Buccolinguomasticory syndrome (face and tongue) • Less common tardive movement disorders • • • •

Tardive dystonia (twisting & bending) Tardive chorea (looks like dancing) Tardive tourettism (looks like Tourette) Tardive tremor or myoclonus (the “shakes” or “jerks”)

• Other tardive syndromes • Akathisia (restlessness) • Pain (oral or genital regions) • Respiratory irregularity

An Example of Tardive Dyskinesia

An Example of Tardive Dystonia

What Causes Tardive Syndromes? 1. Neuroleptics    

phenothiazines butyrophenones benzamides “atypicals”

2. Antiemetics  

metaclopramide prochlorperazine

3. Antidepressants   

tricyclics SSRIs lithium

4. Others  

flunarizine antibiotics

Epidemiology of Tardive Syndromes 1. 2. 3. 3. 4. 5.

Prevalence is ~20% of chronically-treated patients Incidence is ~5% per year during chronic treatment Treatment duration is usually >3 months, often years Susceptibility varies with age (older > younger) Females outnumber males (~1.7 to 1) Other risk factors: treatment duration, dose, brain injury, diabetes, mood disorder

Treatment of Tardive Syndromes 1. Discontinue offending agent (if possible) 2. Other options that sometimes work      

tetrabenazine, reserpine? alternative neuroleptic? vitamin E? anticholinergics, benzodiazepines, baclofen? calcium or beta blockers? brain surgery? Tarvil?

3. Prevention