Tardive Dyskinesia

Tardive Dyskinesia

Tardive dyskinesia is dystonia that can occur as a result of years or decades of administration of neuroleptics and manifests itself in the form of a movement disorder. Patients often grimace or suffer from disturbed breathing or bowel movements. After the manifestation of tardive dyskinesia, the disease is difficult to treat.

What is tardive dyskinesia?

Dystonia is a neurogenic movement disorder that originates in motor brain centers and is attributed to extrapyramidal hyperkinesia. Dystonia usually manifests itself in cramps or poor posture. In medicine, different forms of dystonia are distinguished. One of them is tardive dyskinesia, that is, the delayed motor disorder, also known as tardive dyskinesia or dyskinesia tarda. For comprehensive guide to heart muscle inflammation, please visit growtheology.com.

Such movement disorders often affect the facial area and are expressed in this case in twitching, smacking movements or chewing movements, grimacing or other involuntary combinations of movements. In addition to the face, the extremities can also be affected, which is then referred to as hyperkinesis. Medicine knows two different types of tardive dyskinesia.

This form can be accompanied by severe symptoms of paralysis and mainly affects young people. The condition is also known as drug-induced dystonia because it is often associated with neuroleptics.

Causes

Tardive dyskinesia occurs primarily with the use of older neuroleptics of the butyrophenone or phenothiazine type. Only clozapine does not appear to be associated with tardive dyskinesia. However, olanzapine can cause extrapyramidal movement disorders in a few patients. In the case of conventional, highly potent neuroleptics, the frequency is 15 percent.

Additional risk factors for the movement disorder are smoking, brain damage and older age. The side effects of neuroleptics can occur because the neuroleptic messenger substances also occur in other areas of the nervous system. The dopaminergic transmission of excitation is disturbed by the neuroleptic-induced receptor blockade in the basal ganglia area.

This mechanism of action is considered to be the cause of tardive dyskinesia. Tardive dyskinesia is extrapyramidal hyperkinesia and generally only occurs after long-term therapy with the psychotropic drugs mentioned. Exactly when this manifests varies from case to case.

Symptoms, Ailments & Signs

Tardive orobuccolingual dyskinesia is associated with tics. Patients with this type of tardive dyskinesia rhythmically grimace facially, such as with their entire face, tongue, or mouth. Disorders of breathing and intestinal movement have occurred in very few individual cases.

The same applies to rhythmic movements such as pelvic dyskinesia and continuous movements of the hands. Predominantly younger people often suffer from tardive dyskinesia with significant impairments or the complete loss of bodily functions. Symptoms of paralysis are also conceivable in this context.

Particularly characteristic of tardive dyskinesia are repeated involuntary or purposeless movements such as pursing or pursing the lips or conspicuously fast blinking movements. Involuntary movements of the extremities are less common. Blepharospasm is also a rather rare symptom.

Diagnosis & course of disease

The diagnosis of tardive dyskinesia is made by a neurologist. In addition to visual diagnostics and anamnesis, imaging of the skull plays a role in diagnostics. The prognosis of the patients is relatively unfavorable. Most late kinesias are irreversible and poorly responsive to medication.

Complications

In the context of tardive dyskinesia, those affected suffer from various complications. Typical are tics, which manifest themselves in the form of facial twitching, rapid blinking, breathing disorders and unusual bowel movements. Compulsive movements can also occur in the area of ​​the back and hands, which ultimately lead to a complete loss of bodily functions.

Eyelid cramps, which are accompanied by muscle pain, headaches and tension, rarely occur. Those affected suffer from these obsessive-compulsive disorders physically, since regular tics are accompanied by a range of complaints. However, the biggest complications are psychological. The characteristic appearance of tardive dyskinesia almost always results in an inferiority complex or depression.

Those affected often withdraw from social life or are excluded. This increases the level of suffering and significantly reduces the quality of life. Although treatment is possible, it also carries risks.

The typically prescribed drug botulinum toxin is injected by the doctor into the muscle affected by dyskinesia in order to achieve relaxation. For example, in the case of eye disorders, limitations in facial expressions, dry mouth and eyelid cramps. Other medicines should therefore always be taken under the supervision of a doctor.

When should you go to the doctor?

In the case of tardive dyskinesia, the person affected is dependent on treatment and an examination by a doctor in any case. As a rule, this is the only way to achieve complete healing, since the disease cannot usually be treated by self-help measures and self-healing cannot occur either. A doctor should always be consulted for tardive dyskinesia if the person concerned suffers from severe symptoms. In most cases, the patients feel permanently tired and exhausted and can no longer actively participate in their everyday lives.

Even difficult and strenuous activities can no longer be carried out without problems, so that the everyday life of those affected is severely restricted by tardive dyskinesia. If these symptoms occur and do not go away on their own, you should definitely consult a doctor. Involuntary movements or paralysis in different parts of the body can also indicate tardive dyskinesia. Tardive dyskinesia can be recognized and treated by a general practitioner or neurologist. It cannot be universally predicted whether a cure will occur.

Treatment & Therapy

The only causal therapy for patients with tardive dyskinesia is timely discontinuation of the medication. In many cases, however, this approach is impractical because the problems are identified too late. As soon as tardive dyskinesia becomes manifest, the patients usually only respond inadequately to treatment attempts, since the influence can no longer be reversed even when the symptoms begin.

Drug-based conservative therapy options exist, for example, with dopamine agonistic agents, such as those used in Parkinson’s disease. In addition to lisuride and pergolide, movement-normalizing substances such as tiapride or tizanidine are used.

Physiotherapy can play a role in alleviating the subjectively distressing symptoms. However, the involuntary movements usually elude voluntary control, so that physiotherapy is extremely difficult and lengthy. Since tardive dyskinesia affects social life to a greater or lesser extent, psychological problems can occur.

Psychotherapy is indicated for psychological problems that are already manifest. The patient learns how to better deal with the reactions to his movement disorder. In the recent past, drug therapy has sometimes used botulinum toxin, which in some cases has been able to bring about at least a temporary improvement in the symptoms.

However, all drug treatment steps are to be understood as purely symptomatic therapy. In addition, the additional medications are associated with other side effects, so that a vicious circle occurs. Since tardive dyskinesia is difficult to treat once it has manifested itself, prophylaxis and risk minimization is one of the most important steps.

Prevention

From a pharmacological point of view, the newer atypical neuroleptics show clear differences to older preparations. In the newer variants, tardive dyskinesia is evidently less common. On the other hand, there are significantly fewer long-term studies on the newer substances, so that the dyskinesia risk for many of the new developments cannot be adequately assessed.

Each administration of a highly potent typical neuroleptic increases the individual risk of tardive dyskinesia. In this context, at least little seems to be lost through the alternative use of newer and atypical active substances. Since nicotine consumption also seems to increase the risk, abstaining from nicotine consumption can be regarded as a further preventive measure.

Aftercare

In most cases, those affected with tardive dyskinesia have very few options for direct aftercare. For this reason, the person affected by this disease should consult a doctor as early as possible and also initiate treatment so that complications or other symptoms do not arise in the further course. As a rule, self-healing cannot occur, so that the person concerned should consult a doctor first.

In some cases, the symptoms themselves can be relieved with the help of various medications. The person concerned should always ensure that the medication is taken regularly and that the dosage is correct, so that the symptoms can be alleviated properly and, above all, permanently. If anything is unclear, a doctor should be contacted so that there are no further complications.

The help and support from one’s own family also has a very positive effect on the further course of this disease, which can also prevent depression and other mental upsets. In some cases, tardive dyskinesia also reduces the life expectancy of the sufferer.

You can do that yourself

Self-help measures usually cannot make a visit to the doctor unnecessary, because with certain diseases self-treatment involves an incalculable risk. The situation is different with tardive dyskinesia: it defies all forms of treatment. Patients have to deal with the twitches and involuntary movements of everyday life. Even physiotherapy cannot stop this.

Tardive dyskinesia represents a psychological burden for those affected. Undisturbed communication is hardly possible due to the facial movements that cannot be influenced. Other people misperceive the bodily signals sent. It is not uncommon for an illness to lead to social isolation. There is no effective remedy for this. Even trained therapists can usually not treat such complaints successfully. Only explanations to the interlocutor create clarity and allow less difficult communication.

In the case of tardive dyskinesia, the impossibility of self-treatment extends not only to facial expressions. Twitching of the arms and legs are also possible. They are uncontrolled, cannot be controlled and are therefore not accessible for self-treatment. Some scientists recommend stopping nicotine use. To what extent this leads to a reduction in the unreal movement sequences has not been finally clarified.

Tardive Dyskinesia