Tardive dyskinesia (TD) is a common involuntary, hyperkinetic movement disorder that occurs after long-term use of dopamine receptor blocking agents (DRBA), typically antipsychotics (especially first generation, but can occur with all) and antiemetics (especially metoclopramide or promethazine). Patients should have been exposed to a DRBA for at least 3 months (or 1 month in patients over 60 years). It can also develop after cessation of a DRBA, usually within 4 weeks of an oral agent or 8 weeks of a depot preparation. Rarely, it occurs in reaction to short-term treatment. Increased risk may be seen in older individuals and females, and in those with existing cerebral dysfunction. Occurs commonly in schizophrenic patients on chronic neuroleptic treatment.

TD is sometimes referred to as tardive syndrome, as it may present with several abnormal movements such as akathisia, athetosis, chorea, dyskinesia, dystonia, and tics, alone or in combination. In rare cases, tremor presents. These abnormal movements are most frequently observed in the mouth, lips, and tongue. Less frequently, the movements are seen in the limbs and trunk. Eating and swallowing may be disrupted, and in severe presentations, respiration may be affected.

Orofacial symptoms include protruding / writhing tongue, facial grimacing, sucking / smacking / pouting of the lips, chewing, cheek bulging, and blepharospasm. Limb and trunk symptoms include twisting and jerking fingers, foot tapping, shoulder shrugging, rocking, swaying, and hip thrusting. Opisthotonos (truncal and neck retrocollis) is a common form of TD. Limb and trunk movements are more commonly observed in children.

TD can persist after drug withdrawal for months or years. The condition can be exacerbated by abrupt withdrawal. Some patients are permanently affected.

Related topics: Drug-induced movement disorders, Drug-induced muscle spasm