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Tardive Dyskinesia: Causes, Symptoms, Diagnosis, Treatment, and Prevention

An individual with tardive dyskinesia moves their face, limbs, or torso involuntarily and repetitively. Most medications that affect the dopamine system of the brain, such as antipsychotics and antinausea drugs, can cause it. A person with tardive dyskinesia is more likely to be older, female, or have diabetes or HIV if they take these medications. This blog post will explain tardy dyskinesia, its causes, how it is diagnosed, treated, and prevented.

What is tardive dyskinesia?

The symptoms of tardive dyskinesia usually begin after a long period of taking certain medications. Tardive means delayed or late, so the symptoms usually appear after a long period of taking certain medications.

• Grimacing, eye blinking, tongue thrusting, lip smacking, or puckering of the lips

• Jerking, tapping, rocking, or twisting of the arms, legs, or torso

• Difficulty speaking, swallowing, or breathing

It is involuntary, meaning that the person cannot control these movements. The movements may occur at random or as a result of certain triggers, such as stress, fatigue, or emotions. They can also vary in frequency, intensity, and duration. Some people may have mild symptoms that are barely noticeable, while others may have severe symptoms that interfere with their quality of life and daily activities.

What causes tardive dyskinesia?

Medications that block or reduce the activity of dopamine, a chemical messenger in the brain that regulates movement, mood, and motivation, cause tardive dyskinesia.

• Antipsychotics, which are used to treat mental disorders such as schizophrenia, bipolar disorder, and depression. Examples are haloperidol, chlorpromazine, fluphenazine, and thioridazine.

• Anti-nausea drugs, which are used to prevent or treat vomiting and motion sickness. Examples are metoclopramide and prochlorperazine.

• Other drugs that may affect the dopamine system, such as antidepressants, lithium, and malaria medications.

These medications may cause tardy dyskinesia by altering the sensitivity or number of dopamine receptors in the brain, leading to abnormal nerve signals and muscle movements. Despite this, tardy dyskinesia does not affect everyone who takes these medications. Genetic, environmental, and individual factors may play a role in its development.

How is tardive dyskinesia diagnosed?

Symptoms of tardive dyskinesia may not appear for months or even years after starting or stopping the medication, making it difficult to diagnose. Additionally, the symptoms may be similar to those of Huntington's disease, Parkinson's disease, or cerebral palsy. If you notice any involuntary or unusual movements, especially if you are taking or have taken a medication that can cause tardy dyskinesia, it is important to consult your doctor.

To diagnose tardive dyskinesia, the doctor will ask you about your medical history, including the medications you are taking or have taken, and perform a physical examination. The doctor may use a tool called the Abnormal Involuntary Movement Scale (AIMS) to assess the severity and location of your movements. The doctor may also order blood tests or imaging tests, such as MRI or CT scan, to rule out other causes of abnormal movements.

How is tardive dyskinesia treated?

Although ardive dyskinesia is a chronic and often irreversible condition, it may not go away even when the medication is stopped. Nonetheless, there are a few treatment options available to reduce the symptoms and improve quality of life. The treatment plan may vary according to the individual's condition, preferences, and goals. Treatment options include:

• If possible, the doctor may lower the dose of the medication or change the type of medication that is causing tardy dyskinesia. To avoid worsening symptoms or triggering a relapse of the underlying condition that the medication is treating, this should be done carefully and gradually, under the doctor’s supervision.

• valbenazine or deutetrabenazine are examples of medications that can be prescribed to treat tardy dyskinesia. Inhibitors of the vesicular monoamine transporter 2 (VMAT2) work by decreasing the amount of dopamine released in the brain. It is possible that they can reduce the frequency and severity of involuntary movements, but they may also cause side effects such as drowsiness, dry mouth, or headache.

• The doctor may inject a small amount of botulinum toxin, also known as Botox, into the muscles that are affected by tardy dyskinesia. As a result, the muscles may be relaxed and movements reduced, but it can also cause weakness, pain, or bruising at the injection site. The effect of the injection may last for several months, and repeating it may be necessary.

• When the condition is severe or rare, the doctor may recommend surgery called deep brain stimulation (DBS). This involves implanting a device that delivers electrical impulses into certain parts of the brain that control movement. The dopamine system may be modulated and tardy dyskinesia symptoms may be improved, but complications such as infection, bleeding, or device malfunction may also occur.

How can tardive dyskinesia be prevented?

In order to prevent tardy dyskinesia, it is best to avoid or minimize medications that can cause it as much as possible. Some people need these medications to treat their mental or physical conditions, so this may not be feasible or advisable for them. To reduce the risk of tardy dyskinesia, it is important to follow these steps:

• Talk to your doctor before starting or stopping any medication, especially if it affects the dopamine system. Discuss the benefits and risks of the medication, and ask about alternative options or lower doses, if available.

• Inform your doctor if you experience any abnormal or involuntary movements, or any other side effects, while taking the medication. Do not ignore or dismiss the symptoms, as they may worsen over time.

• Have regular check-ups with your doctor, at least once a year, to monitor your condition and the effects of the medication. The doctor may use the AIMS scale to screen for tardive dyskinesia and adjust your treatment plan accordingly.

• Take good care of your overall health and well-being. Eat a balanced diet, exercise regularly, get enough sleep, and manage your stress. These habits may help boost your immune system, improve your mood, and prevent or delay the onset of tardive dyskinesia.

It is a serious and potentially disabling condition that affects people who take certain medications. With proper diagnosis, treatment, and prevention, it is possible to cope with the condition and live a fulfilling life. Contact your doctor or mental health professional if you have any questions or concerns about tardy dyskinesia. They can provide you with information, support, and resources that will help you cope with it.