title: Tardive dyskinesia: therapeutic options for an increasingly common disorder.
abstract: Tardive dyskinesia (TD) is a serious, often disabling, movement disorder that is caused by medications that block dopamine receptors (i.e., neuroleptics, anti-emetics). There is currently no standard treatment approach for physicians confronted with such patients. This may be the result of notions that TD is disappearing because of the switch to second-generation antipsychotic agents and that it is largely reversible. In this article we demonstrate that second-generation antipsychotics do, indeed, cause TD and, in fact, the frequency is likely higher than expected because of growing off-label uses and a tripling of prescriptions written in the last 10 years. In addition, studies demonstrate that TD actually remits in only a minority of patients when these drugs are withdrawn. Furthermore, neuroleptic agents are often utilized to treat TD, despite prolonged exposure being a risk factor for irreversibility. The outcome of these trends is a growing population afflicted with TD. We review non-neuroleptic agents that have shown positive results in small, early-phase, blinded trials, including tetrabenazine, amantadine, levetiracetam, piracetam, clonazepam, propranolol, vitamin B6, and Ginkgo biloba. Other options, such as botulinum toxin and deep brain stimulation, will also be discussed, and a suggested treatment algorithm is provided. While these agents are reasonable treatment options at this time there is a need, with a concerted effort between neurology and psychiatry, for full-scale drug development, including multicenter, randomized, blinded trials to confirm the effectiveness of the agents that were positive in phase 2 trials and the development of newer ones.
authors: Department of Neurology, Emory University, 1841 Clifton Road NE, Atlanta, GA, 30329, USA.
authors: Leslie J
authors: LJ
authors: Cloud
authors: Deepti
authors: D
authors: Zutshi
authors: Stewart A
authors: SA
authors: Factor
mesh_terms: D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use*; D046690:Deep Brain Stimulation / Q000379:methods*; D004035:Diet Therapy / Q000379:methods*; D006801:Humans; D009069:Movement Disorders / Q000628:therapy*
chemical_list: D018726:Anti-Dyskinesia Agents