Neurotherapeutics

, Volume 11, Issue 1, pp 166–176

Tardive Dyskinesia: Therapeutic Options for an Increasingly Common Disorder

  • Leslie J. Cloud
  • Deepti Zutshi
  • Stewart A. Factor
Review

DOI: 10.1007/s13311-013-0222-5

Cite this article as:
Cloud, L.J., Zutshi, D. & Factor, S.A. Neurotherapeutics (2014) 11: 166. doi:10.1007/s13311-013-0222-5

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 In addition, studies demonstrate that TD actually remits in only a minority of patients when these drugs are withdrawn.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.

Keywords

Tardive dyskinesia Prevalence Reversibility Tetrabenazine Amantadine Levetiracetam 

Supplementary material

13311_2013_222_MOESM1_ESM.pdf (1.2 mb)
ESM 1(PDF 1225 kb)

Copyright information

© The American Society for Experimental NeuroTherapeutics, Inc. 2013

Authors and Affiliations

  • Leslie J. Cloud
    • 1
    • 2
  • Deepti Zutshi
    • 1
  • Stewart A. Factor
    • 1
  1. 1.Department of NeurologyEmory UniversityAtlantaUSA
  2. 2.Department of NeurologyVirginia Commonwealth UniversityRichmondUSA

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