Symptoms of Tardive Dyskinesia
Tardive dyskinesia is characterized by rapid involuntary facial movements including blinking, grimacing, chewing, or tongue movements, along with extremity or truncal movements that are abnormal, repetitive, and purposeless in nature. 1, 2
Orofacial Manifestations (Most Common)
- Rapid involuntary movements of the mouth, lips, and tongue are the hallmark features, presenting as choreiform (dance-like) and athetoid (writhing) movements 1, 3, 4
- Blinking, grimacing, and chewing movements occur frequently in the facial region 1, 2
- Orofacial dyskinesia may include tongue protrusion, lip smacking, and puckering movements 5, 6
- Respiratory dyskinesia is often undiagnosed and includes orofacial dyskinesia, dysphonia (voice changes), dyspnea (breathing difficulty), and can lead to recurrent aspiration pneumonia 1
Limb and Truncal Involvement
- Extremity movements manifest as involuntary, irregular, repetitive movements that are purposeless 7, 5
- Truncal dyskinesias can occur, though less frequently than orofacial symptoms 6, 4
- These movements extend beyond the face to involve the limbs and trunk in choreoathetoid patterns 5
Tardive Dystonia (Related Subtype)
- Characterized by slow movements along the long axis of the body that culminate in spasms, distinguishing it from classic TD 1
- Facial spasms occur alongside neck, back, and limb muscle involvement 1
- This variant can be quite disabling and is often associated with tardive dyskinesia 1
Important Clinical Distinctions
Classic TD involves choreiform and athetoid movements, NOT tremor as a primary feature 2, 3. If tremor develops while on antipsychotics, consider drug-induced Parkinsonism instead, which presents with bradykinesia, tremors, and rigidity—particularly if occurring early in treatment 3.
Temporal Characteristics
- TD develops during exposure to or withdrawal from neuroleptics in patients with a history of neuroleptic use for at least 3 months, or 1 month in patients 60 years or older 7
- The movements are potentially irreversible even after medication discontinuation, making early recognition essential 2, 5
- TD occurs in approximately 5% of young patients per year and is more common with older "typical" antipsychotics 1
Assessment Tool
The Abnormal Involuntary Movement Scale (AIMS) is the standardized measure for monitoring TD, scoring involuntary movements across body regions on a 0-4 scale, with items 1-7 assessing severity across different anatomical areas 1, 8.