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Relationship between tardive dyskinesia, l-Dopa-induced hyperkinesia and parkinsonism


In a study of 16 psychotic patients with neuroleptic-induced tardive dyskinesia and 16 patients with Parkinson's disease and l-Dopa-induced hyperkinesia kinesia it was found that (1) tardive dyskinesia, compared to l-Dopa hyperkinesia, was localized almost exclusively to the oral region (P<0.01), whereas the l-Dopa hyperkinesia was more pronounced in the neck (P<0.05) and the extremities (P<0.05); (2) l-Dopa hyperkinesia showed an increasing tendency to oral preponderance with age, irrespective of the severity of parkinsonism and extra-oral hyperkinesia, while tardive dyskinesia only itensified with age, without any change in distribution; and (3) extraoral l-Dopa hyperkinesia was related to the localization and severity of pretreatment parkinsonism, and more to bradykinesia than to rigidity and tremor. It is concluded that the irreversible neurotoxic effect of neuroleptic drugs may be associated with agerelated changes in the oral somatotopic region of the basal ganglia (to be given consideration in any future search for the pathogenetic process underlying irreversible tardive dyskinesia), and that the pathophysiology of involuntary hyperkinesia in neuroleptic-treated psychiatric patients and in l-Dopatreated Parkinson patients may consist of a primary dopamine deficiency (pharmacological or structural), and a secondary relative hyperactivity in the dopaminergic system (“dopaminergic hypersensitivity”) possibly corresponding to hypoactivity in the cholinergic system.

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  1. Ayd, F. J.: Persistent dyskinesia: a neurologic complication of major tranquilizers. Med. Sci. 18, 32–40 (1967)

  2. Barbeau, A.: l-Dopa therapy in Parkinson's disease: A critical review of nine years' experience. Canad. med. Ass. J. 101, 791–800 (1969)

  3. Bernheimer, H., Birkmayer, W., Hornykiewicz, O., Jellinger, K., Seitelberger, F.: Brain dopamine and the syndromes of Parkinson and Huntington. Clinical, morphological and neurochemical correlations. J. neurol. Sci. 20, 415–455 (1973)

  4. Birket-Smith, E.: Abnormal involuntary movements induced by anticholinergic therapy. Acta neurol. scand. 50, 801–811 (1974)

  5. Carlsson, A.: Biochemical implications of dopa-induced actions on the central nervous system, with particular reference to abnormal movements. In: l-Dopa and Parkinsonism, A. Barbeau and F. H. McDowell, eds., pp. 205–213. Philadelphia: F. A. Davis 1970

  6. Chase, T. N., Holden, E. M., Brody, J. A.: Levodopa-induced dyskinesias. Arch. Neurol. (Chic.) 29, 328–330 (1973)

  7. Cotzias, G. C.: Levodopa in the treatment of Parkinsonism. J. Amer. med. Ass. 218, 1903–1908 (1971)

  8. Crane, G. E.: Tardive dyskinesia in patients treated with major neuroleptics: A review of the literature. Amer. J. Psychiat. 124, 40–48 (1968)

  9. Crane, G. E.: Pseudoparkinsonism and tardive dyskinesia. Arch. Neurol. (Chic.) 27, 426–430 (1972)

  10. Crane, G. E.: Persistent dyskinesia. Brit. J. Psychiat. 122, 395–405 (1973)

  11. Crane, G. E.: Factors predisposing to drug-induced neurologic effects. In: The phenothiazines and structurally related drugs. I. S. Forrest, C. J. Carr and E. Usdin, eds., pp. 269–279. New York: Raven Press 1974

  12. Divac, I.: Neostriatum and functions of prefrontal cortex. Acta Neurobiol. exp. 32, 461–477 (1972)

  13. Fann, W., Lake, R.: On the coexistence of Parkinsonism and tardive dyskinesia. Dis. nerv. Syst. 35, 324–326 (1974)

  14. Gerlach, J., Reisby, N., Randrup, A.: Dopaminergic hypersensitivity and cholinergic hypofunction in the pathophysiology of tardive dyskinesia. Psychopharmacologia (Berl.) 34, 21–35 (1974)

  15. Gerlach, J., Thorsen, K.: The movement pattern of oral tardive dyskinesia in relation to anticholinergic and antidopaminergic treatment. Int. Pharmacopsychiat. 11, 1–7 (1976)

  16. Hassler, R.: Extra-pyramidal-motorische Syndrome und Erkrankungen. In: Handbuch der inneren Medizin, vol. 4, G. v. Bergmann, W. Frey, H. Schwiegk and R. Jung, eds., pp. 676–904. Berlin-Göttingen-Heidelberg: Springer 1955

  17. Hoehn, M. M., Yahr, M. D.: Parkinsonism: Onset, progression, and morality. Neurology (Minneap.) 17, 427–442 (1967)

  18. Klawans, H. L.: The pharmacology of extrapyramidal movement disorder. Basel-München-Paris-London-New York-Sidney. Karger 1973

  19. Klawans, H. L., Rubovits, R.: Effect of cholinergic and anticholinergic agents on tardive dyskinesia. J. Neurol. Neurosurg. Psychiat. 27, 941–947 (1974)

  20. Künzle, H.: Bilateral projections from precentral motor cortex to the putamen and other parts of the basal ganglia. An autoradiographic study in Macaca fascicularis. Brain Res. 88, 195–209 (1975)

  21. Markham, C. H.: The choreoathetoid movement disorder induced by levodopa. Clin Pharmacol. Ther. 12, 340–343 (1971)

  22. Mones, R. J., Elizan, T. S., Siegel, G. J.: Analysis of l-Dopa induced dyskinesia in 61 patients with parkinsonism. J. Neurol. Neurosurg. Psychiat. 34, 668–673 (1971)

  23. Szabo, J.: Topical distribution of the striatal efferents in the monkey. Exp. Neurol. 5, 21–36 (1962)

  24. Ungerstedt, U.: Postsynaptic supersensitivity after 6-hydroxydopamine induced degeneration of the nigro-striatal dopamine system. Acta physiol. scand., Suppl. 367, 69–93 (1971)

  25. Voneida, T. J.: An experimental study of the course and destination of fibers arising in the head of the caudate nucleus in the cat and monkey. J. comp. Neurol. 115, 75–87 (1960)

  26. Webster, D. D.: Critical analysis of the disability in Parkinson's disease. Modern Treatment 5, 257–282 (1968)

  27. Weiner, W. J., Klawans, H. L.: Lingual-facial-buccal movements in the elderly. I. Pathophysiology and treatment. J. Amer. Geriat. Soc. 21, 314–317 (1973)

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Correspondence to Jes Gerlach.

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Gerlach, J. Relationship between tardive dyskinesia, l-Dopa-induced hyperkinesia and parkinsonism. Psychopharmacology 51, 259–263 (1977). https://doi.org/10.1007/BF00431633

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Key words

  • Tardive dyskinesia
  • l-Dopa-induced hyperkinesia
  • Parkinson's disease