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 2. Antiemetics
 phenothiazines  metaclopramide
 butyrophenones  prochlorperazine
 benzamides 3. Antidepressants
 “atypicals”  tricyclics
 SSRIs
 lithium
4. Others
 flunarizine
 antibiotics
Epidemiology of Tardive Syndromes

1. Prevalence is ~20% of chronically-treated patients

2. Incidence is ~5% per year during chronic treatment
3. Treatment duration is usually >3 months, often years
3. Susceptibility varies with age (older > younger)
4. Females outnumber males (~1.7 to 1)
5. 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