How Is Tardive Dyskinesia (TD) Diagnosed?

Tardive dyskinesia (TD), also called linguofacial dyskinesia or oral-facial dyskinesia, is a neurological condition that results in abnormal movements that typically affect the face, lips, jaw, or tongue due to the use of a type of medication called dopamine receptor blockers. 

• These medications may be prescribed for certain psychiatric disorders (such as schizophrenia, depression, or bipolar disorders) and gut issues (such as nausea and vomiting).
• Not everyone who uses dopamine receptor blockers, however, develops TD.
• In some people, TD may present in a severe form called tardive dystonia.

Symptoms of tardive dyskinesia (TD) include uncontrollable (involuntary) movements mainly limited to the face although other parts of the body may be affected.

Some of the symptoms of TD include:

• Facial grimacing (usually involves the lower part of the face)
• Sticking out or thrusting the tongue
• Swinging movements of the jaw
• Repetitive chewing
• Finger movements (as though playing a piano or typing)
• Frequent blinking
• Sucking, puckering, or fish-like movement of the mouth
• Duck-like walk (pelvic rocking or thrusting)
• Chorea (quick, jerking movements of the arms or legs)
• Athetosis (slow, twisting movements of the arms or legs)
• Tardive dystonia (slower, twisting movements of larger muscles of the face, neck, and trunk)
• Restlessness

Tardive dyskinesia (TD) is caused by the long-term use of dopamine receptor blockers (antagonists).

• Long-term use, such as for years, of these medications, causes certain biochemical changes in a part of the brain called the striatum that may result in involuntary movements in certain parts of the body.
• Some people may develop TD even after short-term use of dopamine receptor blockers.

Due to the differences in the susceptibility of a person to develop TD, researchers argue that genes may play some role in causing this condition. So far, however, no definitive genetic abnormalities have been identified as a cause of TD.

Dopamine receptor blockers act by preventing the binding of (blocking) the brain chemical (neurotransmitter) called dopamine to its binding sites (receptors) in the brain. Dopamine helps the nerve cells or neurons communicate with each other, and any disruption in it may lead to neurological symptoms such as abnormal movements (dyskinesia).

Some of the medications that may cause TD include:

• Antipsychotics (neuroleptics) such as haloperidol, risperidone, olanzapine, loxapine, amisulpride, and fluphenazine
• Antiemetics (used to treat nausea, vomiting, or acid reflux) such as metoclopramide and prochlorperazine
• Antidepressants such as selective serotonin reuptake inhibitors (such as fluoxetine), tricyclic antidepressants (such as amitriptyline, doxepin, and imipramine), phenelzine, and trazodone
• Antianxiety medications such as alprazolam
• Antimalarials such as chloroquine
• Mood stabilizers such as lithium
• Levodopa
• Antihistamines
• Stimulants such as caffeine, amphetamine, and methylphenidate

The treatment of tardive dyskinesia (TD) mainly involves discontinuation of the culprit medication as soon as the symptoms appear. This must only be done under the supervision of the doctor who may prescribe an alternative (such as atypical antipsychotics) if necessary. In some people, however, stopping the medication may not be possible or carry significant risk.

Some people, however, may not improve despite the withdrawal of the neuroleptic medication. Furthermore, stopping the medication may not be safe for some people. In such cases, other drugs may be prescribed to manage the symptoms. The U.S. Food and Drug Administration approved Ingrezza (valbenazine) and Austedo (deutetrabenazine) in 2017 for the treatment of tardive dyskinesia (TD) in adults.

Other treatments that may be given to treat TD include:

• Benzodiazepines
• Botox injections
• Deep brain stimulation

There is no definite way to prevent tardive dyskinesia (TD) because the medications that cause it do not affect everyone the same way. Thus, one cannot be sure whether avoiding certain medications is necessary. Furthermore, some medications may be absolutely necessary, and avoiding them may not be an option for a person.

The only thing the person can do is observe for any abnormal or involuntary movements and bring them to their doctor’s notice at the earliest. The doctor may screen the person for any signs of TD by careful examination including examination of the tongue, face, trunk, and limbs.