A blessing in disguise: resolution of tardive dyskinesia with development of cervical myelitis.
Tardive dyskinesia (TD), which is frequently seen in patients treated with dopamine receptor blocking agents, is difficult to manage. We report on a young Chinese man with bipolar disorder who developed TD after haloperidol treatment, involving the trunk, limbs, and orofacial area. TD persisted despite switching to atypical antipsychotic agents and treatment with valproate, benzodiazepines, and tetrabenazine. Resolution only occurred years later when he developed quadriplegia arising from infective myelitis of the cervical cord (C4-5). He had concomitant vertebral osteomyelitis, which was successfully treated with intravenous antibiotics. With intensive rehabilitation, he recovered the use of his limbs, but had no recurrence of TD. We attribute the resolution of orofacial dyskinesias with a cervical lesion to the interconnections between the orofacial area and cervical spine via the trigeminal nucleus (which has fibers descending as far caudally as C6), as well as to resetting of cortical maps.
Lim
Erle Chuen-Hian
EC
Division of Neurology, National University Hospital, Singapore. mdcelch@nus.edu.sg
Wilder-Smith
Einar P V
EP
Seet
Raymond Chee-Seong
RC
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D002574:Cervical Vertebrae; D004409:Dyskinesia, Drug-Induced / Q000175:diagnosis*; D005500:Follow-Up Studies; D006220:Haloperidol / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009187:Myelitis / Q000175:diagnosis* / Q000534:rehabilitation; D009460:Neurologic Examination / Q000187:drug effects; D010019:Osteomyelitis / Q000175:diagnosis / Q000534:rehabilitation; D011782:Quadriplegia / Q000175:diagnosis / Q000534:rehabilitation; D012075:Remission, Spontaneous
D014150:Antipsychotic Agents; D006220:Haloperidol