Signs and Symptoms of Tardive Dyskinesia

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Tardive dyskinesia (TD) is a movement disorder characterized by 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.

It is caused by long-term use of neuroleptic drugs as well as other drugs that increase the brain's sensitivity to the neurotransmitter dopamine.

Symptoms of Tardive Dyskinesia

Tardive dyskinesia causes repetitive, involuntary, and purposeless movements and tics often in the face such as:

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

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.

Causes

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.

One theory about the cause of tardive dyskinesia (TD) is that over time, blocking dopamine receptors on nerve cells can cause the brain to compensate by creating more dopamine receptors and making them more sensitive, which can lead to tardive dyskinesia.

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. These include:

  • Women
  • Elderly people
  • People with diabetes
  • People with mood disorders
  • People with other neurological conditions

Diagnosis

Tardive dyskinesia can be difficult to diagnose. Symptoms do not appear until the medication has been taken for months or years, and can first appear after ceasing treatment.

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.

Your doctor may take additional tests including blood work and brain scans to rule out other causes.

Differential Diagnoses

Symptoms of tardive dyskinesia are similar to the following conditions:

  • Huntington’s Disease: An inherited neurological illness, Huntington's disease is characterized by involuntary movements, loss of motor control, changes in gait, loss of memory, 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 patients over a 10- to 20-year period.
  • Cerebral Palsy: Caused by a brain injury in early development, cerebral palsy 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: A neurological movement disorder which begins in childhood between the ages of 2 and 16, Tourette's syndrome 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 it treats.

Treatment for Tardive Dyskinesia

If you've been diagnosed with tardive dyskinesia, decreasing the dosage or discontinuing the medication causing the condition may solve your problems. However, it 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.

Dyskinesia Doctor Discussion Guide

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Medications

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

  • Ingrezza (Valbenazine): The only medicine approved solely for treating tardive dyskinesia, Once-daily 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.

  • 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.

  • 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 can reduce and relieve tardive symptoms.
  • Botox (Botulinum Toxin): Botox can be used to freeze facial muscles to reduce movements and alleviate pain, a small study found.
  • Klonopin (Clonazepam): Benzodiazepines, like Klonopin, may be prescribed to treat tardive dyskinesia. There is limited research proving it is an effective treatment strategy, however, according to a 2018 analysis published in the Cochrane Database of Systematic Reviews. 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 With Tardive Dyskinesia

Always keep detailed records of any medications you are taking—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, he or she 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.

Coping with tardive dyskinesia can feel difficult and stigma associated with the condition's repetitive movements, isolating. If you feel alone, consider joining a support group or online support community.

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.

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