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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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