Tardive Dystonia Follow-up

  • Author: Daniel Schneider, MD; Chief Editor: Iqbal Ahmed, MBBS, FRCPsych (UK)   more...
 
Updated: Jan 5, 2011
 

Inpatient & Outpatient Medications

According to conventional wisdom, the new atypical antipsychotic medications, which appear to have less adverse extrapyramidal and tardive dystonic effects, have decreased the incidence of this syndrome. To this point, no rigorous studies support this belief.

BTTA injections appear to be a good development in the treatment of tardive dyskinesia, especially the tardive cranial and cervical forms.

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Deterrence/Prevention

Unless necessary, avoid use of all drugs that may be offending agents. Before beginning treatment, consider carefully the risks and benefits of using medications such as neuroleptics for nonindicated uses (eg, sedation) or at doses higher then clinically necessary.

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Prognosis

The prognosis of patients with tardive dystonia is very poor. Unfortunately, once developed, this condition is usually persistent.

  • The discontinuation of all dopamine receptor antagonists appears to be the most important factor related to remission; patients who permanently discontinue these agents increase their chance of remission 4-fold compared with those patients who do not.
  • Another factor related to remission is the total duration of dopamine receptor antagonist therapy; patients taking dopamine receptor antagonists for less than 10 years have a 5-times higher chance of remission than those with more than 10 years of exposure.
  • Tardive dystonia is most likely permanent in patients who continue using neuroleptic drugs for more than 10 years.
  • The indication for long-term use of neuroleptic agents must be well established. Patients must be evaluated repeatedly in hopes of early detection of tardive dystonia; once tardive dystonia is present, the causative drug should be withdrawn if possible. If the patient is not disabled by dyskinesia, observing and hoping for a spontaneous recovery, rather than treating, is best.
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Patient Education

For excellent patient education resources, visit eMedicine's Back, Ribs, Neck, and Head Center. Also, see eMedicine's patient education article Torticollis.

Organizations such as WE MOVE and the Dystonia Foundation provide excellent resources for patients and families. Both sites provide education about dystonia and resources for support and advocacy around the world, and the Dystonia Foundation in particular has many inexpensive resources available for purchase. One nice patient information sheet on dystonia in general is freely downloadable from Life In Motion.

Some other online resources for information on tardive dystonia specifically can be found at the Tardive Dyskinesia Center and the National Alliance on Mental Illness.

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Contributor Information and Disclosures
Author

Daniel Schneider, MD  Movement Disorders Fellow, Center for Parkinson's Disease and Other Movement Disorders, Columbia University Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Paula D Ravin, MD  Associate Professor of Clinical Neurology, University of Massachusetts Memorial Health Care

Paula D Ravin, MD is a member of the following medical societies: American Academy of Neurology, American Headache Society, American Medical Association, Massachusetts Medical Society, and National Headache Foundation

Disclosure: Acadia Pharmaceuticals Grant/research funds Other; Bayer Pharmaceuticals Grant/research funds None; Teva Pharmaceuticals Grant/research funds Other

Specialty Editor Board

Alan D Schmetzer, MD  Professor Emeritus, Interim Chairman, Vice-Chair for Education, Associate Residency Training Director in General Psychiatry, Fellowship Training Director in Addiction Psychiatry, Department of Psychiatry, Indiana University School of Medicine; Addiction Psychiatrist, Midtown Mental Health Cener at Wishard Health Services

Alan D Schmetzer, MD is a member of the following medical societies: American Academy of Addiction Psychiatry, American Academy of Clinical Psychiatrists, American Academy of Psychiatry and the Law, American College of Physician Executives, American Medical Association, American Neuropsychiatric Association, American Psychiatric Association, and Association for Convulsive Therapy

Disclosure: Eli Lilly & Co. Grant/research funds Other

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Harold H Harsch, MD  Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin

Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: lilly Honoraria Speaking and teaching; Forest Labs None None; Pfizer Grant/research funds Speaking and teaching; Northstar None None; Novartis Grant/research funds research; Pfizer Honoraria Speaking and teaching; Sunovion Speaking and teaching; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research; Merck Honoraria Speaking and teaching

Chief Editor

Iqbal Ahmed, MBBS, FRCPsych (UK)  Faculty, Department of Psychiatry, Tripler Army Medical Center; Clinical Professor of Psychiatry, Clinical Professor of Geriatric Medicine, University of Hawaii, John A Burns School of Medicine

Iqbal Ahmed, MBBS, FRCPsych (UK) is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, American Psychiatric Association, American Society of Clinical Psychopharmacology, and Royal College of Psychiatrists

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Nestor Galvez-Jimenez, MD, and Perla Periut, MD, to the development and writing of this article.

References

  1. Fahn S, Marsden, CD, Calne DB. Classification and Investigation of Dystonia. In: Marsden CD, Fahn S. Movement Disorders, Vol. 2. London: Butterworths; 1987:332-358.

  2. Fahn, Stanley and Jankovic, Joseph. Principles and Practice of Movement Disorders. Philadelphia, PA: Churchill Livingston Elveiser; 2007.

  3. Stacy, Mark A. Handbook of Dystonia. New York, NY: Informa Healthcare; 2007.

  4. Keegan DL, Rajput AH. Drug induced dystonia tarda: treatment with L-dopa. Dis Nerv Syst. Mar 1973;34(3):167-9. [Medline].

  5. Burke RE, Fahn S, Jankovic J, et al. Tardive dystonia: late-onset and persistent dystonia caused by antipsychotic drugs. Neurology. Dec 1982;32(12):1335-46. [Medline].

  6. Kang UJ, Burke RE, Fahn S. Tardive dystonia. Adv Neurol. 1988;50:415-29. [Medline].

  7. Adityanjee, Aderibigbe YA, Jampala VC, Mathews T. The current status of tardive dystonia. Biol Psychiatry. Mar 15 1999;45(6):715-30. [Medline].

  8. Sachdev P. Risk factors for tardive dystonia: a case-control comparison with tardive dyskinesia. Acta Psychiatr Scand. Aug 1993;88(2):98-103. [Medline].

  9. Mihara K, Kondo T, Higuchi H, Takahashi H, Yoshida K, Shimizu T. Tardive dystonia and genetic polymorphisms of cytochrome P4502D6 and dopamine D2 and D3 receptors: a preliminary finding. Am J Med Genet. Aug 8 2002;114(6):693-5. [Medline].

  10. Trugman JM, Leadbetter R, Zalis ME, Burgdorf RO, Wooten GF. Treatment of severe axial tardive dystonia with clozapine: case report and hypothesis. Mov Disord. Jul 1994;9(4):441-6. [Medline].

  11. Yassa R, Nair V, Iskandar H. A comparison of severe tardive dystonia and severe tardive dyskinesia. Acta Psychiatr Scand. Aug 1989;80(2):155-9. [Medline].

  12. Friedman JH, Kucharski LT, Wagner RL. Tardive dystonia in a psychiatric hospital. J Neurol Neurosurg Psychiatry. Jun 1987;50(6):801-3. [Medline].

  13. Sethi KD, Hess DC, Harp RJ. Prevalence of dystonia in veterans on chronic antipsychotic therapy. Mov Disord. 1990;5(4):319-21. [Medline].

  14. Kiriakakis V, Bhatia KP, Quinn NP, Marsden CD. The natural history of tardive dystonia. A long-term follow-up study of 107 cases. Brain. Nov 1998;121 (Pt 11):2053-66. [Medline].

  15. Gimenez-Roldan S, Mateo D, Bartolome P. Tardive dystonia and severe tardive dyskinesia. A comparison of risk factors and prognosis. Acta Psychiatr Scand. May 1985;71(5):488-94. [Medline].

  16. Burke RE. Neuroleptic-induced tardive dyskinesia variants. In: Lang AE, Weiner WJ, eds. Drug-Induced Movement Disorders. New York, NY: Futu; 1992:168-98.

  17. Vandel P, Bonin B, Leveque E, et al. Tricyclic antidepressant-induced extrapyramidal side effects. Eur Neuropsychopharmacol. Aug 1997;7(3):207-12. [Medline].

  18. Gabellini AS, Pezzoli A, De Massis P, Sacquegna T. Veralipride-induced tardive dystonia in a patient with bipolar psychosis. Ital J Neurol Sci. Oct 1992;13(7):621-3. [Medline].

  19. Chakrabarti S, Chand PK. Lithium - induced tardive dystonia. Neurol India. Dec 2002;50(4):473-5. [Medline].

  20. Chase TN, Tamminga CA, Burrows H. Positron emission tomographic studies of regional cerebral glucose metabolism in idiopathic dystonia. Adv Neurol. 1988;50:237-41. [Medline].

  21. Arai N, Amano N, Iseki E, et al. Tardive dyskinesia with inflated neurons of the cerebellar dentate nucleus. Case reports and morphometric study. Acta Neuropathol (Berl). 1987;73(1):38-42. [Medline].

  22. Kaufman DM. Use of botulinum toxin injections for spasmodic torticollis of tardive dystonia. J Neuropsychiatry Clin Neurosci. Winter 1994;6(1):50-3. [Medline].

  23. Hennings JM, Krause E, Bötzel K, Wetter TC. Successful treatment of tardive lingual dystonia with botulinum toxin: case report and review of the literature. Prog Neuropsychopharmacol Biol Psychiatry. Jul 1 2008;32(5):1167-71. [Medline].

  24. Shapleske J, Mickay AP, Mckenna PJ. Successful treatment of tardive dystonia with clozapine and clonazepam. Br J Psychiatry. Apr 1996;168(4):516-8. [Medline].

  25. Blake LM, Marks RC, Nierman P, Luchins DJ. Clozapine and clonazepam in tardive dystonia. J Clin Psychopharmacol. Aug 1991;11(4):268-9. [Medline].

  26. Trottenberg T, Volkmann J, Deuschl G, Kühn AA, Schneider GH, Müller J. Treatment of severe tardive dystonia with pallidal deep brain stimulation. Neurology. Jan 25 2005;64(2):344-6. [Medline].

  27. Zhang JG, Zhang K, Wang ZC. Deep brain stimulation in the treatment of tardive dystonia. Chin Med J (Engl). May 5 2006;119(9):789-92. [Medline].

  28. Thobois S, Ballanger B, Xie-Brustolin J, Damier P, Durif F, Azulay JP, et al. Globus pallidus stimulation reduces frontal hyperactivity in tardive dystonia. J Cereb Blood Flow Metab. Jun 2008;28(6):1127-38. [Medline].

  29. Gruber D, Trottenberg T, Kivi A, Schoenecker T, Kopp UA, Hoffmann KT, et al. Long-term effects of pallidal deep brain stimulation in tardive dystonia. Neurology. Jul 7 2009;73(1):53-8. [Medline].

  30. Berg D, Becker G, Naumann M, Reiners K. Morphine in tardive and idiopathic dystonia (short communication). J Neural Transm. 2001;108(8-9):1035-41. [Medline].

  31. Burke RE, Kang UJ. Tardive dystonia: clinical aspects and treatment. In: Jankovic J, Tolosa E, eds. Facial Dyskinesias. New York, NY: Raven; 1988:200-10.

  32. Chatterjee A, Forrest Gordon M, Giladi N, Trosch R. Botulinum toxin in the treatment of tardive dystonia. J Clin Psychopharmacol. Dec 1997;17(6):497-8. [Medline].

  33. Eidelberg D, Moeller JR, Ishikawa T, et al. The metabolic topography of idiopathic torsion dystonia. Brain. Dec 1995;118 (Pt 6):1473-84. [Medline].

  34. Fahn S. Concept and classification of dystonia. Adv Neurol. 1988;50:1-8. [Medline].

  35. Franzini A, Marras C, Ferroli P, Zorzi G, Bugiani O, Romito L. Long-term high-frequency bilateral pallidal stimulation for neuroleptic-induced tardive dystonia. Report of two cases. J Neurosurg. Apr 2005;102(4):721-5. [Medline].

  36. Gruber D, Trottenberg T, Kivi A, Schoenecker T, Kopp UA, Hoffmann KT, et al. Long-term effects of pallidal deep brain stimulation in tardive dystonia. Neurology. Jul 7 2009;73(1):53-8. [Medline].

  37. Manteghi A, Hojjat SK, Javanbakht A. Remission of tardive dystonia with electroconvulsive therapy. J Clin Psychopharmacol. Jun 2009;29(3):314-5. [Medline].

  38. Reich SG. Dystonia. In: Johnson RT, Griffin JW, eds. Current Therapy in Neurologic Disease. St Louis, Mo: Mosby Year-Book; 1997:286-90.

  39. Simpson GM. The treatment of tardive dyskinesia and tardive dystonia. J Clin Psychiatry. 2000;61 Suppl 4:39-44. [Medline].

  40. Suzuki T, Matsuzaka H. Drug-induced Pisa syndrome (pleurothotonus): epidemiology and management. CNS Drugs. 2002;16(3):165-74. [Medline].

  41. van Harten PN, Kahn RS. Tardive dystonia. Schizophr Bull. 1999;25(4):741-8. [Medline].

  42. van Harten PN, Matroos GE, Van Os J. The course of tardive dystonia in Afro Caribbean patients, a population-based study: the Curacao extrapyramidal syndromes study: VII. Schizophr Res. Jan 2008;98(1-3):79-83. [Medline].

 
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