eMedicine Specialties > Psychiatry > Psychosomatic

Dystonia, Tardive: Follow-up

Author: Daniel Schneider, MD, MA, Chief Resident, Departments of Psychiatry and Neurology, University of Massachusetts
Coauthor(s): Paula D Ravin, MD, Associate Professor of Clinical Neurology, University of Massachusetts Memorial Health Care
Contributor Information and Disclosures

Updated: Aug 31, 2009

Follow-up

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.

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.

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in hopes of early detection of tardive dystonia; once tardive dystonia is present, the causative drug should be withdrawn if possible.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.

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.

 
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.



More on Dystonia, Tardive

Overview: Dystonia, Tardive
Differential Diagnoses & Workup: Dystonia, Tardive
Treatment & Medication: Dystonia, Tardive
Follow-up: Dystonia, Tardive
References
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Further Reading

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Keywords

tardive dystonia, muscle contractions, dyskinesia, repetitive movement, abnormal posture, muscle twitch, twitching, involuntary movement, writer's cramp, blepharospasm, geste antagonistique, abnormal muscle spasm, anti-psychotic drug treatment, antipsychotic drug treatment, anti-psychotics, antipsychotics, neuroleptic-induced tardive dyskinesia, dystonic movement, focal striatal lesion, dystonic posture, Westphal phenomenon, neuroleptics, neuroleptic agents, neuroleptic drugs, torticollis, oromandibular dystonia, dystonic adductor dysphonia, focal dystonia, segmental cranial dystonia, segmental axial dystonia, segmental brachial dystonia, segmental crural dystonia, multifocal dystonia, generalized dystonia, hemidystonia, hemi-dystonia, stereotactic thalamotomy, thalamotomy, selective denervation

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Contributor Information and Disclosures

Author

Daniel Schneider, MD, MA, Chief Resident, Departments of Psychiatry and Neurology, University of Massachusetts
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: Santhera Phameuticals Grant/research funds Other; Kyowa Pharmaceuticals Grant/research funds Other; Acadia Pharmaceuticals Grant/research funds Other; Bayer Pharmaceuticals None None

Medical Editor

Alan D Schmetzer, MD, Professor, Vice-Chair for Education, and Director of Residency Training in General and Addiction Psychiatry, Department of Psychiatry, Indiana University School of Medicine
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: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Iqbal Ahmed, MBBS, Professor, Department of Psychiatry, John A Burns School of Medicine, University of Hawaii
Iqbal Ahmed, MBBS is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

CME Editor

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 Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Speaking and teaching; Northstar Grant/research funds Research; Novartis Grant/research funds research; Pfizer  Speaking and teaching; Sanofi-avetis Grant/research funds research; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
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