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Tardive dyskinesia
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Tardive dyskinesia

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Contributors: Erin Keenan MLIS, Richard L. Barbano MD, PhD
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Synopsis

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

Codes

ICD10CM:
G24.01 – Drug induced subacute dyskinesia

SNOMEDCT:
102449007 – Tardive dyskinesia

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Huntington disease – Can have dystonia along with chorea, and may have had psychiatric symptoms treated with an antipsychotic. Query about family history of abnormal movements, psychiatric illnesses, or early departure from the family in a parent.
  • Torsion dystonia – Retrocollis is much less common in idiopathic cervical dystonia than in TD.
  • Oromandibular dystonias can appear very similar to TD. Look for more dystonia (jaw opening and closing or lateral deviation) in idiopathic oromandibular dystonia, and more persistent movement in TD.
  • Neuroacanthocytosis – Can present with significant oromandibular dyskinesias.
  • Parkinson disease – Dopamine receptor blockers also can produce some component of parkinsonism (drug-induced parkinsonism).
  • Edentulous dyskinesia – Recent or even remote loss of teeth can trigger involuntary mouth movements, especially in the elderly.
  • Tics – May involve oral movements. Look for vocalizations in Tourette syndrome.
  • Psychomotor seizures – Look for any alteration of level of consciousness.
  • Systemic lupus erythematosus
  • Wilson disease
  • Autoimmune or neoplastic channelopathies
  • Neurodegeneration with brain iron accumulation (NBIA)

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 01/05/2018
Last Updated: 08/14/2019
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Tardive dyskinesia
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Tardive dyskinesia : Antipsychotic
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