title: Successful treatment of tardive lingual dystonia with botulinum toxin: case report and review of the literature.
abstract: Tardive dyskinesia (TD) is a dreaded side effect of antipsychotic medication. Recommended treatments for TD may provide reliable improvement but can be, in turn, associated with additional adverse reactions. Recently, several reports have suggested that botulinum toxin A (BTX-A) injection in affected muscles may significantly improve TD. Here, we report a case of severe tongue protrusion dystonia secondary to an antipsychotic medication in a young man. Several approaches including clozapine, amisulpride, aripiprazole, ziprasidone, tiapride and clonazepam failed to improve the symptoms. Injection of 50 U of BTX-A (Dysport, Ipsen, Ettlingen, Germany) into each genioglossal muscle dramatically improved tongue protrusion within few days with a sustained effect. If reasonable precautions are taken, the application seems to be well tolerated with only minor side effects. A review of the literature that is part of this article adverts BTX-A injection as a potential beneficial approach of various kinds of TD.
authors.affiliation: Max Planck Institute of Psychiatry, Kraepelinstrasse 2-10, D-80804 Munich, Germany. hennings@mpipsykl.mpg.de
authors.forename: Johannes M H
authors.initials: JM
authors.lastname: Hennings
authors.forename: Eike
authors.initials: E
authors.lastname: Krause
authors.forename: Kai
authors.initials: K
authors.lastname: Bötzel
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Wetter
mesh_terms: D000328:Adult; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects; D001905:Botulinum Toxins / Q000627:therapeutic use*; D004409:Dyskinesia, Drug-Induced / Q000188:drug therapy* / Q000209:etiology; D004421:Dystonia / Q000139:chemically induced / Q000188:drug therapy*; D006801:Humans; D008297:Male; D012559:Schizophrenia / Q000188:drug therapy; D014060:Tongue Diseases / Q000139:chemically induced / Q000188:drug therapy*
chemical_list: D018726:Anti-Dyskinesia Agents; D014150:Antipsychotic Agents; D001905:Botulinum Toxins