- Risk Factors
What is tardive dyskinesia?
Dyskinesias are involuntary movements of the face (including lips, tongue, eyes), trunk, and extremities, which are identified in patients who have been treated with certain (dopamine-antagonist) medications.
Dyskinesias are difficult to control. Many different conditions can lead to dyskinetic movements, including rheumatic fever, genetic disorders, or unusual disorders such as motor tics and paroxysmal nonkinesigenic dyskinesia. Dyskinetic movements can include eye blinking or closure, mouth opening or lip pursing, involuntary tongue movements, or more pronounced movements of the extremities or trunk. Sometimes, dyskinetic movements can include sustained abnormal postures; in these cases, the movements are called dystonia.
Tardive dyskinesias are a subgroup of dyskinesias that occur after exposure to certain types of medication. The most common medications that can lead to tardive dyskinesia include antipsychotic medications and medications used to treat chronic nausea. This class of medications is often used to treat psychiatric conditions such as schizophrenia, severe depression or anxiety, or bipolar disorder. Often stereotyped, these drug-induced movement disorders include orofacial dyskinesias, or involuntary movements of the mouth, eyes, and tongue. The movements can range from intermittent and infrequent to almost constant.
How common is tardive dyskinesia?
The number of people who develop tardive dyskinesia is unknown, but estimates suggest that about 5%-6% of those who take neuroleptic or anti-nausea medications may develop symptoms; this number rises to about 25% of the elderly population. Sometimes tardive dyskinesia isn’t seen until the medication is stopped (this is called withdrawal dyskinesia); others find that their symptoms resolve after restarting the medication or adjusting the dose (this is known as “masked tardive dyskinesia”).
What is tardive dyskinesia primarily caused by?
Although medications can trigger tardive dyskinesia, the underlying reason or cause of tardive dyskinesia remains unknown. Scientists speculate that medication-induced changes to a specific region in the brain (dopamine-2 or D-2 receptors) may lead to the movements, but this theory has not been proven yet.
What are drugs cause tardive dyskinesia?
While antipsychotic medications -- including first- and second-generation antipsychotics -- metoclopramide, and antiemetics have been implicated in the onset of tardive dyskinesia, the underlying cause remains unclear.
Who is most likely to suffer from tardive dyskinesia?
Risk factors for tardive dyskinesia include:
- Gender (older females are more likely to develop tardive dyskinesia, whereas younger males seem more likely to develop tardive dystonia)
- Duration of exposure to antipsychotic medications
- A dose of antipsychotic medications
- Cigarette smoking.
What are the warning signs of tardive dyskinesia?
There are many different symptoms associated with tardive dyskinesia, including:
- Twisting movements of the tongue or tongue protrusion
- Lip pursing or smacking
- Cheek bulging or “puffing out”
- Chewing actions
- Eye closure
The facial movements may interfere with speaking or eating.
Other symptoms or signs include:
- Involuntary actions of the hands or feet, including persistent finger movements or toe extension
- Shoulder shrugging
- Neck movements (including pulling the head back or pushing it forward)
- Rocking activity
- Hip movements
- In rare cases, irregular breathing
Common symptoms of tardive dyskinesia
- Involuntary facial movements, especially tongue protrusion. In some cases, the tongue movements are so pronounced that the person’s tongue begins to grow, exacerbating the problems with protrusion.
- Lip pursing and grunting also are frequently identified in cases of tardive dyskinesia.
- Sometimes a person with tardive dyskinesia will appear to be chewing on something.
When the person is distracted, the movements are often worse; however, if the affected person becomes aware of the movements, he or she is often able to stop or decrease the activity.
What is the difference between dystonia and tardive dyskinesia?
When patients develop sustained twisting or abnormal postures related to medication use, a diagnosis of tardive dystonia may be made.
Akathisia vs. tardive dyskinesia
Akathisia is a sense of pronounced restlessness and an inability to sit still. People with akathisia will often pace, fidget, or march for hours on end. Unlike tardive dyskinesia, which occurs after several months or years of treatment, akathisia may arise after a single dose of a medication. Akathisia may be described as acute, occurring shortly after starting a medication, or tardive, occurring many months or years after starting the medication.
- Attachment Theory: What It Is, Stages & the Different Attachment Styles
- Gentle Parenting: What It Is, Techniques & Discipline
- U.S. Nursing Homes Fail to Report Many Serious Falls, Bedsores: Study
- The Younger You Get Diabetes, the Higher Your Risk for Dementia Later
- FDA Grants Full Approval to Paxlovid to Treat COVID-19
- More Health News »
What specialists treat tardive dyskinesia?
Psychiatrists and neurologists, especially those who specialize in treating movement disorders, are most experienced in treating tardive dyskinesia.
How is tardive dyskinesia diagnosed?
Tardive dyskinesia is diagnosed after careful clinical examination and assessment of a patient’s history. Healthcare professionals consider and exclude other movement disorders, including drug-induced movement disorders, before making a diagnosis of tardive dyskinesia.
Is there a test for tardive dyskinesia?
Tardive dyskinesia is a clinical diagnosis, meaning that there are no blood tests, X-rays, or other objective assessments which can confirm this condition. Physicians often use the Abnormal Involuntary Movement Scale (AIMS) to quantify movements, which appear to be tardive dyskinesia. This scale is a numeric score that grades involuntary movements from 0-4 in 10 different areas, including muscles of facial expression, lips/perioral area, jaw, tongue, upper extremities, lower extremities, neck, shoulders, hips, severity of overall movements, and patient awareness of the movements. Many sources suggest that patients who are treated with antipsychotic medications be rated before initiating treatment and every 3 months thereafter.
Healthcare professionals consider conditions such as thyroid disorders, parathyroid conditions, Sydenham chorea, syphilis, Wilson disease, and Meige syndrome (idiopathic orofacial dystonia) before making a diagnosis of tardive dyskinesia, as treatment is much different in those conditions.
What are tardive dyskinesia treatment options?
Treatment of tardive dyskinesia is often difficult; in some cases, symptoms may escalate if a medication is stopped abruptly. Although discontinuation of the drug thought to be the cause of tardive dyskinesia is suggested followed by a trial of an alternate antipsychotic agent, this is not always a feasible solution for patients, and sometimes stopping the current antipsychotic medication may exacerbate the symptoms.
Is medication for tardive dyskinesia available?
- Dopamine-depleting medications -- including tetrabenazine, deutetrabenazine, valbenazine, and reserpine -- can all be beneficial to help alleviate symptoms of tardive dyskinesia. Although tetrabenazine has been used for many years to treat tardive dyskinesia, it has not received FDA approval for this application. Deutetrabenazine and valbenazine are FDA-approved medications to treat tardive dyskinesia.
- Benzodiazepines may be of benefit to some patients.
- Botulinum toxin injections can be helpful for certain symptoms such as blepharospasm or isolated dystonia.
Are there natural remedies for tardive dyskinesia?
Some patients have successfully used Ginkgo biloba for control of their tardive dyskinesia. Researchers evaluated vitamin E but found it to be ineffective.
Subscribe to MedicineNet's General Health Newsletter
Is tardive dyskinesia reversible?
Tardive dyskinesia can be treated or even reversed in many patients. Early identification and treatment of this condition are often the most successful in controlling the symptoms.
Can tardive dyskinesia be prevented?
The most effective strategy in controlling tardive dyskinesia is prevention; this includes short-term use of antipsychotic medications and regular assessment of whether patients need to remain on the medication. Experts recommend that the use of metoclopramide be limited to less than 3 months.
What research for tardive dyskinesia is underway?
Studies looking at the potential benefit of pyridoxine, as well as attempting to quantify the incidence of tardive dyskinesia are underway. Further information can be found at clinicaltrials.gov.
Brain and Nervous System Resources
Health Solutions From Our Sponsors
Health Solutions From Our Sponsors
Caroff. S. “Overcoming barriers to effective management of tardive dyskinesia.” Neuropsychiatric Disease and Treatment. 2019; 15: 785-794.
Dhir, A., and T. Schilling, V. Abler, R. Potluri, and B. Carroll. “Estimation of tardive dyskinesia incidence and prevalence in the United States [abstract].” Movement Disorders. 2017; 32 (suppl 2).
Waln, O., and J. Jankovic. “An update on tardive dyskinesia: from phenomenology to treatment.” Tremor and Other Hyperkinetic Movements. 12 July 2013; 1-11.
Top Tardive Dyskinesia Related Articles
Brain PictureThe brain is one of the largest and most complex organs in the human body. See a picture of the Brain and learn more about the health topic.
How Can I Get My Eye To Stop Twitching?A blepharospasm (eye twitch) is a harmless, involuntary spasm of the muscle of the eyelids, which may resolve on its own. If the twitching isn't caused by an underlying condition, getting more rest and avoiding alcohol and caffeine may help stop it.
How Conditions Change Your BrainThe brain doesn’t always stay the same. Mental disorders, health issues, and lifestyle habits can alter the way it looks and works.
How Is Tardive Dyskinesia (TD) Diagnosed?Tardive dyskinesia (TD) is mainly diagnosed based on characteristic signs and symptoms and medical history.
How Serious Is Tardive Dyskinesia?Tardive dyskinesia symptoms can make it difficult to carry out daily physical tasks, lowering one's quality of life.
How the Brain Works: Test Your Medical IQTake this quiz and test your knowledge of how the human brain works. You may be surprised!
Is Tardive Dyskinesia Brain Damage?Tardive dyskinesia is a movement disorder caused by certain kinds of medication, including some antipsychotics and antidepressants. Tardive dyskinesia is brain damage in the sense that it’s likely caused by permanent alterations to your brain's biochemistry.
Muscle Cramps (Charley Horse) and Muscle SpasmsWhat are the differences between muscle spasms and cramps? Learn about the causes of muscle spasms and cramps (charley horse) in the calf, leg, and more.
Muscle SpasmsMuscle spasms are involuntary muscle contractions that come on suddenly and are usually quite painful. Dehydration, doing strenuous exercise in a hot environment, prolonged muscle use, and certain diseases of the nervous system may cause muscle spasms. Symptoms and signs of a muscle spasm include an acute onset of pain and a possible bulge seen or felt beneath the skin where the muscle is located. Gently stretching the muscle usually resolves a muscle spasm.
Parkinson's DiseaseParkinson's disease is a slowly progressive neurological disease characterized by a fixed inexpressive face, a tremor at rest, slowing of voluntary movements, a gait with short accelerating steps, peculiar posture and muscle weakness, caused by degeneration of an area of the brain called the basal ganglia, and by low production of the neurotransmitter dopamine. Most patients are over 50, but at least 10 percent are under 40.
Parkinson's Disease: Eating RightEating a well-balanced and nutritional diet is very beneficial to people with Parkinson's disease. With a proper diet, our bodies work more efficiently and it is especially helpful because Parkinson's disease medications will work properly.
Parkinson's SlideshowDiscover the symptoms, causes, stages, and treatment options for Parkinson's disease. Learn more about the stages of Parkinson's disease such as tremors and loss of muscle control.
Parkinson's QuizParkinson's disease is common among neurodegenerative disorders. Do you know how it works? The causes? The symptoms? Take the Parkinson’s Disease Quiz to Test your knowledge of Parkinson's.
Weird Body Quirks: From Brain Freeze to HiccuppingIce cream brain freeze, hiccups, charley horses, vertigo--what's behind these weird body quirks anyway? Our experts explain several odd body behaviors.
When Should I Be Worried About Eye Twitching?An eye/eyelid twitch (myokymia), is an involuntary, repeated spasm of the eyelid muscle. It can happen in the upper or lower lids. Eye twitching is usually painless and harmless. It often resolves without treatment. Though less common, eye twitching is sometimes the first sign of a chronic movement disorder.
Why Are My Eyes Twitching?Eye twitching, or blepharospasm, is a condition in which you cannot keep your eyes open for a long time due to spasms. The main causes of eye twitch include fatigue, stress, smoking, caffeine, medication side effects, light sensitivity, lack of sleep, foreign particles in the eye, and corneal irritation.
Why Do Antipsychotics Cause Tardive Dyskinesia?Antipsychotics cause certain biochemical changes in the brain and disrupt the neuronal communication of dopamine resulting in neurological symptoms, such as tardive dyskinesia.