Symptoms and Causes of Tardive Dyskinesia

Tardive dyskinesia (TD) is a movement disorder that causes symptoms of uncontrolled facial movements, such as repetitive tongue movements, chewing or sucking motions, and involuntarily making faces. It may also involve movements of the limbs or torso.

Tardive dyskinesia is caused by the long-term use of neuroleptic drugs as well as other drugs that increase the brain's sensitivity to the neurotransmitter dopamine. Neuroleptic drugs are antipsychotic medications used to treat psychosis in schizophrenia, bipolar disorder, and other types of psychotic disorders.

Tardive Dyskinesia Symptoms

Tardive dyskinesia causes repetitive, involuntary, and purposeless movements and tics. These movements often occur in the face and may include:

• Chewing or sucking movements
• Grimacing (making faces)
• Lip-smacking
• Puckering or pursing the lips
• Rapid eye blinking
• Tongue protrusion
• Worm-like tongue movements

People with tardive dyskinesia may also experience uncontrolled movements in arms, legs, and torso, including toe-tapping, hip rocking, and uncontrollable finger movements that look as though the person is playing an invisible guitar or piano.

Diagnosis

Tardive dyskinesia can be difficult to diagnose. While it is a side effect of certain medications, symptoms do not appear until the medication has been taken for months or years, and can sometimes first appear after ceasing treatment. Your doctor may take additional tests including blood work and brain scans to rule out other causes.

If you are taking neuroleptics, your doctor should screen for tardive dyskinesia annually. The standard physical examination for this uses the Abnormal Involuntary Movement Scale (AIMS) to detect and rate abnormal movements.

Symptoms of tardive dyskinesia are similar to the following conditions. To diagnose TD, your doctor needs to rule out these other possibilities.

Huntington’s Disease

Huntington's disease is an inherited neurological illness characterized by involuntary movements, loss of motor control, gait changes, memory loss, and dementia. Also known as Huntington’s Chorea, symptoms generally first appear between ages 30 and 50. Unlike tardive dyskinesia, Huntington's disease is progressive and severely weakens those who have it over a 10- to 20-year period.

Cerebral Palsy

Cerebral palsy is caused by a brain injury in early development and is characterized by impaired muscle control or coordination and sensory deficits. People with cerebral palsy can have facial movements that resemble tardive dyskinesia.

Tourette's Syndrome

Tourette's syndrome is a neurological movement disorder that begins in childhood between the ages of 2 and 16 and is characterized by involuntary muscular movements called “tics” and uncontrollable vocal sounds.

People with Tourette's are often prescribed neuroleptic drugs such as haloperidol and pimozide, so it may be difficult to determine if the movements are due to the medication or the condition the medication is intended to treat.

Dystonia

Dystonia is a type of movement problem that can occur in Parkinson's disease. It can lead to muscle stiffening in various parts of the body including the face, eyes, neck, torso, limbs, and feets. It is distinguishable from dyskinesia by the stiffening of muscles versus the involuntary movement of muscles.

Causes of Tardive Dyskinesia

Tardive dyskinesia is a very serious side effect of antipsychotic medications, mainly due to the use of typical antipsychotics. Although less likely, the newer and atypical antipsychotics may also cause the disorder.

Medications that can cause TD include:

• Chlorpromazine
• Haloperidol
• Thioridazine

It may also occur as a side effect with some antiepileptic drugs, antidepressants, antiemetics, and anticholinergics. 

The majority of cases of TD are due to the use of antipsychotics (neuroleptics), however, other categories of medications, such as certain anti-nausea drugs and other psychiatric medication, have been connected with the development of TD.

Risk Factors

Anyone who has taken neuroleptic drugs for an extended period of time can develop tardive dyskinesia, but some individuals are at greater risk, including:

• Women
• People over age 55
• People with diabetes
• People with mood disorders
• People with other neurological conditions
  

Tardive Dyskinesia Medications and Treatment

If you've been diagnosed with tardive dyskinesia, decreasing the dosage or discontinuing the medication causing the condition may solve your problems. However, this approach can also cause symptoms to worsen.

If symptoms worsen, they may eventually go away, or they may continue indefinitely. For the best outcome, it is important to get diagnosed and discuss treatment as early as possible.

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Medications

A number of medications have been used to try to control the symptoms of tardive dyskinesia including:

• Austedo (deutetrabenazine): FDA-approved for the treatment of chorea associated with Huntington's disease, Austedo may ease symptoms. A clinical trial published in Neurology in 2017 found Austedo significantly reduced AIMS scores in patients with dyskinesia compared to placebo.
• Botox (botulinum toxin): Botox can be used to freeze facial muscles to reduce movements and alleviate pain, a small study found.
• Clozaril (clozapine): While this drug is in the category of agents that can cause tardive dyskinesia, it may also help treat it. According to a 2018 meta-analysis published in the Journal of Clinical Psychiatry, switching patients from their existing medicine to Clozaril was shown to reduce and relieve tardive symptoms.
• Ingrezza (valbenazine): The only medicine approved solely for treating tardive dyskinesia, Ingrezza was shown to improve tardive dyskinesia symptoms compared to placebo. A 2017 study published in the American Journal of Psychiatry found treatment with Ingrezza significantly reduced AIMS scores.
• Klonopin (clonazepam): Benzodiazepines like Klonopin may be prescribed to treat tardive dyskinesia. According to a 2018 analysis published in the Cochrane Database of Systematic Reviews, there is limited research proving it is an effective treatment strategy. In addition, Klonopin can be habit-forming and should be used with caution.

Other Treatments

For those with severe symptoms, deep brain stimulation may also be tried. More commonly used with Parkinson's disease, deep brain stimulation involves implanting electrodes in certain areas of your brain to produce electrical stimulation that regulates abnormal impulses.

Researchers are studying new ways to treat tardive dyskinesia, which may include antioxidants such as vitamin E, red rice bran oil, and curcumin.

Coping

Always keep detailed records of any medications you are taking, including when you start them, what the dosage is, and any dosage changes. If you begin to experience any of the symptoms listed above, speak with your doctor and share your prescription history with them.

While your prescribing doctor should have your medication history, they may not have it in a compact form or you may not be able to visit that particular doctor if you need assistance in a hurry. It's also possible that your psychiatrist will notice symptoms of tardive dyskinesia before you are aware of them.

It can help to share your frustrations, especially among those who understand what you are going through. Inspire, an organization known for its many support communities, has a group specifically for those living with tardive dyskinesia.