What is Tardive Dyskinesia
Tardive dyskinesia (TD) is an involuntary movement disorder characterized by repetitive, purposeless, and potentially irreversible movements, primarily affecting the orofacial region but capable of involving any body part, that develops from long-term exposure to dopamine receptor-blocking agents, particularly antipsychotics. 1
Clinical Characteristics
Movement Patterns:
- TD manifests as rapid involuntary facial movements combined with extremity or truncal choreiform and athetoid movements 2
- The orofacial region is most commonly affected, though movements can occur throughout the body 1, 3
- Tremor is NOT a primary feature of classic TD—if tremor develops early during antipsychotic treatment, consider drug-induced parkinsonism instead 2
- A related variant, tardive dystonia, presents with slow movements along the body's long axis culminating in spasms, potentially including facial spasms 4
Causative Agents
Primary Culprits:
- Antipsychotic medications (both typical and atypical) are the most common cause 1, 5, 6
- Metoclopramide can cause potentially irreversible TD, particularly in elderly patients, and should be avoided for long-term use 1
- Any dopamine receptor-blocking agent carries risk 3, 7
Diagnostic Criteria
Temporal Requirements:
- TD develops during exposure to or withdrawal from neuroleptics in patients with at least 3 months of neuroleptic use 8
- In patients 60 years or older, only 1 month of exposure is required for diagnosis 8
Natural History and Prognosis
Irreversibility Concerns:
- The syndrome consists of potentially irreversible, involuntary, dyskinetic movements 5, 6
- The risk of permanence and irreversibility increases with greater treatment duration and higher cumulative doses 5, 6, 3
- TD may persist even after medication discontinuation 1, 4
- However, the syndrome can develop after relatively brief treatment periods at low doses 5, 6
- TD may remit partially or completely if antipsychotic treatment is withdrawn, though this is not guaranteed 6, 9
Epidemiology and Risk Factors
Prevalence:
- TD develops in approximately 20% of neuroleptic-treated patients overall 10
- Up to 50% of youth receiving neuroleptics may experience some form of tardive or withdrawal dyskinesia 1, 4
High-Risk Populations:
- Elderly patients, especially elderly women, have substantially higher rates 6, 10
- Female sex is a risk factor 10
- Patients with affective disorders 10
- Total drug exposure is positively correlated with TD risk 10
Physical and Psychological Impact
- Because these movements are out of the patient's control, they can have serious physical and psychological effects 3
- The involuntary nature makes TD particularly debilitating and distressing for patients 9