Tardive Dyskinesia

What Is Tardive Dyskinesia?

Tardive dyskinesia is a drug-induced movement disorder in which sudden, uncontrollable movements happen in the face and body because of prolonged use of medication, typically anti-psychotic drugs. “Tardive” means delayed or late. Dyskinesia refers to abnormal, involuntary, or repeated muscle movements.

Tardive dyskinesia affects over 500,000 people in the United States. Females (especially post-menopausal women), older adults, and people of African descent have a higher risk of developing tardive dyskinesia.

Tardive Dyskinesia Symptoms

Tardive dyskinesia symptoms usually develop after you’ve taken a medication for months or years. Some people can develop the condition after as little as six weeks, but this is less common.

The condition causes different kinds of uncontrolled movements in the face, arms, legs, or torso.

Abnormal facial movements may include the following:

• Blinking eyes rapidly
• Chewing motions
• Frowning or grimacing
• Grunting
• Puffing out cheeks
• Smacking or puckering lips or making a sucking noise with the mouth
• Sticking out the tongue or poking it into the inside of the cheek

Abnormal movements affecting the arms, legs, or torso may include:

• Rocking the pelvis back and forth
• Swaying from side to side
• Tapping the feet
• Waddling movement when walking
• Wiggling or tapping the fingers (as if playing the piano)

In rare cases, tardive dyskinesia may affect breathing or cause the eyes to stick in a certain position (usually looking upward). Both of these symptoms require immediate treatment.

Causes of Tardive Dyskinesia

Long-term use of medications that block the activity of the chemical messenger (neurotransmitter) dopamine in the brain can cause tardive dyskinesia. These medications are used to treat psychiatric conditions, nausea, seizures, and other conditions. Experts do not yet know why these medications cause tardive dyskinesia in some people, while other people have no problems.

General groups of medications that can cause tardive dyskinesia include:

• Neuroleptics (also known as anti-psychotics) used to treat psychiatric conditions, especially older versions of the drugs
• Certain anti-depressants and mood stabilizers
• Certain anti-nausea medications
• Certain anti-seizure medications
• Decongestants, such as pseudoephedrine and phenylephrine
• Medications for movement disorders
• Levodopa (used to treat Parkinson’s disease)

Tardive Dyskinesia Diagnosis

Diagnosing tardive dyskinesia can be difficult because symptoms may start at any time after beginning the triggering medication. If you take any medications known to cause tardive dyskinesia, your doctor may recommend some tests to rule out other movement disorders.

These tests may include:

• Blood and urine tests to check for illnesses, infections, and other abnormal findings
• Electroencephalography (EEG) to measure and record the electrical activity of the brain
• Electromyography (EMG) to assess the quality of the electrical signals that the nerves send to the muscles
• Neurological physical examination to check your reflexes, sensation, strength, and coordination to see how well your nervous system is functioning

Tardive Dyskinesia Treatment

Symptoms of tardive dyskinesia may get better or disappear when you stop taking or lower the dose of the medication causing symptoms. Switching to another medication that is less likely to cause tardive dyskinesia may also reduce symptoms.

If changing medications doesn’t work or isn’t an option, your doctor may prescribe drugs to help to manage and improve symptoms. In cases where tardive dyskinesia affects breathing, doctors may recommend deep brain stimulation.

Medications

Drugs that change the way nerves send signals to muscles can help control involuntary movements. Such medications include:

• Botulinum toxin injections: Your provider injects a small amount into a specific muscle or muscle group to briefly weaken or paralyze the muscles. This can prevent involuntary movements that are localized to one area, such as the face.
• Deutetrabenazine/tetrabenazine: These medications control the involuntary movements that occur due to Huntington’s disease but can also treat tardive dyskinesia symptoms. They work by changing the activity of dopamine in the brain.
• Valbenazine: This medication specifically treats tardive dyskinesia. It lessens the abnormal movements of the face, tongue, and body by decreasing the amount of dopamine, serotonin, and norepinephrine in the brain.

Surgery

Deep brain stimulation (DBS) may be a treatment option if symptoms of tardive dyskinesia affect your breathing or do not improve with medication changes.

DBS involves placement of a battery-operated medical device in the chest (similar to a heart pacemaker). A neurosurgeon implants wires into specific areas of the brain causing involuntary movements. The device sends electrical signals through the wires to the brain and disrupts abnormal brain activity. This can reduce the symptoms of tardive dyskinesia.

Care for Tardive Dyskinesia at Penn Medicine

Caring for people with tardive dyskinesia means managing multiple conditions at the same time. At Penn Medicine’s Movement Disorders Center, we treat more people with tardive dyskinesia than any other program in the region. Our expert team has the skill and experience necessary to safely relieve symptoms of tardive dyskinesia without compromising care for other conditions.

Make an Appointment

Please call 800-789-7366 or make an appointment.

Penn Programs & Services for Tardive Dyskinesia