Tardive dyskinesia (TD) is a movement disorder that causes symptoms of uncontrolled facial movements, such as repetitive tongue movements, chewing or sucking motions, and involuntarily making faces. It may also involve movements of the limbs or torso.1
Tardive dyskinesia is caused by the long-term use of neuroleptic drugs as well as other drugs that increase the brain’s sensitivity to the neurotransmitter dopamine. Neuroleptic drugs are antipsychotic medications used to treat psychosis in schizophrenia, bipolar disorder, and other types of psychotic disorders.
The National Alliance on Mental Health suggests that around 25% of people who take these medications will develop tardive dyskinesia. While serious, treatments are available.2
Tardive Dyskinesia Symptoms
Tardive dyskinesia causes repetitive, involuntary, and purposeless movements and tics. These movements often occur in the face and may include:1
- Chewing or sucking movements
- Grimacing (making faces)
- Lip-smacking
- Puckering or pursing the lips
- Rapid eye blinking
- Tongue protrusion
- Worm-like tongue movements
People with tardive dyskinesia may also experience uncontrolled movements in arms, legs, and torso, including toe-tapping, hip rocking, and uncontrollable finger movements that look as though the person is playing an invisible guitar or piano.
Diagnosis
Tardive dyskinesia can be difficult to diagnose. While it is a side effect of certain medications, symptoms do not appear until the medication has been taken for months or years, and can sometimes first appear after ceasing treatment. Your doctor may take additional tests including blood work and brain scans to rule out other causes.
If you are taking neuroleptics, your doctor should screen for tardive dyskinesia annually. The standard physical examination for this uses the Abnormal Involuntary Movement Scale (AIMS) to detect and rate abnormal movements.
Abnormal Involuntary Movement Scale (AIMS)
The AIMS scale was designed by the National Institute of Health to assess different types of dyskinesia. A healthcare provider assesses a variety of factors, including facial muscle expression, lips, jaw, tongue, upper appendages, lower appendages, neck, and awareness of involuntary movements. Each question is rated on a scale from none to severe.3
Symptoms of tardive dyskinesia are similar to the following conditions.4 To diagnose TD, your doctor needs to rule out these other possibilities.
Huntington’s Disease
Huntington’s disease is an inherited neurological illness characterized by involuntary movements, loss of motor control, gait changes, memory loss, and dementia. Also known as Huntington’s Chorea, symptoms generally first appear between ages 30 and 50. Unlike tardive dyskinesia, Huntington’s disease is progressive and severely weakens those who have it over a 10- to 20-year period.
Cerebral Palsy
Cerebral palsy is caused by a brain injury in early development and is characterized by impaired muscle control or coordination and sensory deficits. People with cerebral palsy can have facial movements that resemble tardive dyskinesia.
Tourette’s Syndrome
Tourette’s syndrome is a neurological movement disorder that begins in childhood between the ages of 2 and 16 and is characterized by involuntary muscular movements called “tics” and uncontrollable vocal sounds.
People with Tourette’s are often prescribed neuroleptic drugs such as haloperidol and pimozide, so it may be difficult to determine if the movements are due to the medication or the condition the medication is intended to treat.
Dystonia
Dystonia is a type of movement problem that can occur in Parkinson’s disease. It can lead to muscle stiffening in various parts of the body including the face, eyes, neck, torso, limbs, and feets. It is distinguishable from dyskinesia by the stiffening of muscles versus the involuntary movement of muscles.
Recap
Tardive dyskinesia is typically diagnosed by observing symptoms and talking to others who may have also observed these symptoms. A healthcare provider will also need to rule out other potential causes, including Huntington’s disease, cerebral palsy, Tourette’s syndrome, and dystonia.
Causes of Tardive Dyskinesia
Tardive dyskinesia is a very serious side effect of antipsychotic medications, mainly due to the use of typical antipsychotics. Although less likely, the newer and atypical antipsychotics may also cause the disorder.1
Medications that can cause TD include:
- Chlorpromazine
- Haloperidol
- Thioridazine
It may also occur as a side effect with some antiepileptic drugs, antidepressants, antiemetics, and anticholinergics.
One theory about the cause of tardive dyskinesia (TD) is that over time, blocking dopamine receptors on nerve cells can cause the brain to compensate by creating more dopamine receptors and making them more sensitive, which can lead to tardive dyskinesia.
The majority of cases of TD are due to the use of antipsychotics (neuroleptics), however, other categories of medications, such as certain anti-nausea drugs and other psychiatric medication, have been connected with the development of TD.
Risk Factors
Anyone who has taken neuroleptic drugs for an extended period of time can develop tardive dyskinesia, but some individuals are at greater risk, including:4
- Women
- People over age 55
- People with diabetes
- People with mood disorders
- People with other neurological conditions