Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

Tardive Dyskinesia 1407

■Body rocking & swaying motions of the trunk

■Gait may be abnormal w/ leg jerking

■While standing in place, may shift weight

■Breathing may be irregular

tests

■Diagnosis made clinically

■Laby tests & brain imaging are normal

differential diagnosis

■Acute drug-induced movement disorders, stroke, neurodegenera-

tive disorders (Huntington’s disease, Wilson’s disease, Tourette syn-

drome, edentulouness (or poorly fitting dentures), vasculitis, psy-

chogenic causes excluded clinically

■Metabolic disorders (hyperparathyroidism, hyperthyroidism, hepa-

tocerebral degeneration) & vasculitis (lupus erythematosus, periar-

teritis nodosa) excluded by lab tests & brain imaging

management

■Preventive: avoid long-term, high-dose treatment w/ neuroleptics

➣Taper dopamine receptor antagonist slowly

➣Substitute atypical neuroleptics for high-potency D2 antagonists

specific therapy

■No definitive treatment available

■If symptoms persist & are significantly disruptive, consider treatment

w/:

➣Reserpine

➣Tetrabenazine (not available in U.S.)

➣L-dopa, dopamine agonists in low doses may help some pts

➣Amantadine, lithium, valproate, benzodiazepines, baclofen may

also be tried

➣If these agents not helpful (or for those who suffer ongoing psy-

chosis), atypical neuroleptics (eg, quetiapine, olanzapine, cloza-

pine) helpful

follow-up

■Depends on severity & whether treatment is indicated

complications and prognosis

■Symptoms regress spontaneously in 5–30% (but may take years)

■Better prognosis for younger pts