Tardive Dyskinesia

Tardive dyskinesia (TD) is a neurological disorder. It is caused by long-term use of specific medications; medications used to treat neurological, psychiatric and gastrointestinal disorders. Tardive dyskinesia is a serious disorder and can be permanent.

Certain drugs used to treat specific disorders have been found to be the cause of tardive dyskinesia. With TD, the patient’s nerve cells misfire, resulting in involuntary movements. Research has shown that when patients have been taking certain prescription drugs for a long duration, they develop these movement disorders because the neurons (nerve cells) misfire. Tardive dyskinesia has been linked to the drug, metoclopramide (otherwise known as Reglan and Maxolon). The disorder has also been linked to antipsychotics, and antidepressant drugs, which inhibit the path of nerve cells.

As a result of having tardive dyskinesia, patients may suffer from many symptoms, including:

• Facial tics
• Grimacing
• Repeated eye blinking
• Lip smacking/pursing/puckering
• Puffing of cheeks
• Tongue protrusion
• Rapid arm movements
• Restless leg syndrome
• Impaired movement of fingers
• Involuntary movements of the head, face, or nec

Diagnosis of tardive dyskinesia can be challenging. Some drugs that cause TD, such as Reglan, can actually mask symptoms making patients unaware they have this disorder. TD is also difficult to diagnose because when antipsychotic drugs bring on the disorder, the TD symptoms may take years after the drugs were taken to appear. Diagnosing tardive dyskinesia is especially difficult because many of the symptoms associated with this disorder are very similar to other movement disorders, such as Tourette’s syndrome, Parkinson’s disease, dystonia, akathisia, and myoclonus. Physicians must determine which of the aforementioned disorders the patient is suffering from by observing which particular muscles are moving involuntarily.

Tardive dyskinesia has most recently been in the news because of Reglan, a drug designed to treat acid reflux disease, heartburn, and gastrointestinal disorders. Although Reglan has been approved for short-term use (just 1-3 months), chronic use of Reglan has been linked to serious side effects. As a result, the U.S. Food & Drug Administration (FDA) ordered a Black Box Warning for Reglan in late February 2009. The Black Box Warning is the most serious warning the FDA gives. This warning expressly states the risk of developing tardive dyskinesia from long-term use of Reglan. In fact, FDA data shows that nearly 30% of patients using Reglan for over a year develop TD, the drug-induced movement disorder. For more information on Reglan, check out our blog.

There are several factors that may put some individuals in more danger of getting tardive dyskinesia than others. For example, studies have shown that patients who take antipsychotic drugs for longer than one year have a 20% chance of developing tardive dyskinesia. Furthermore, studies have suggested that children and infants are susceptible to developing tardive dyskinesia. This is especially true when considering the young age group frequently suffers from gastrointestinal problems, and is therefore prescribed metoclopramide for reflux treatment. However, the Journal of the American Medical Association published an article that indicated 31% of all tardive dyskinesia patients are over the age of 55. Another risk factor is gender. Research shows TD is also more common in females. Other risk factors include: mental disabilities, substance abuse, and diabetes.

Treatment of tardive dyskinesia is also difficult. There is not any accepted or standard treatment for tardive dyskinesia. Attempts at treatment are specific to individual patients. Some patients will experience fewer symptoms or symptoms may even disappear after they stop taking specific drugs. According to some studies, at least 50% of patients will experience remission of some symptoms of TD within 12-18 months. The symptoms lessen because the patients have stopped taking the drugs that cause tardive dyskinesia. However, in some patients, taking fewer drugs may actually increase their TD symptoms, making them dependent on the drugs. For countless others suffering from tardive dyskinesia, the disorder is often irreversible. Therefore, the most effective treatment method is to try to stop TD before it happens. Monitoring which drugs patients are using and how long patients are taking those drugs can prevent people from getting tardive dyskinesia.

Some research is being conducted to discover more about tardive dyskinesia and other movement disorders. As there is currently no accepted cure or treatment for tardive dyskinesia, research into this disorder is greatly needed.

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