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What is Tardive Dyskinesia?

What is Tardive Dyskinesia?. H. A. Jinnah, MD, PhD Associate Professor of Neurology Johns Hopkins University. Tardive Dyskinesia. “Late” or “Delayed”. “Abnormal movement”. Tardive Dyskinesia Manifestations. Buccolinguomasticory syndrome (face and tongue)

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What is Tardive Dyskinesia?

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  1. What is Tardive Dyskinesia? H. A. Jinnah, MD, PhDAssociate Professor of NeurologyJohns Hopkins University

  2. Tardive Dyskinesia “Late” or “Delayed” “Abnormal movement”

  3. Tardive Dyskinesia Manifestations • Buccolinguomasticory syndrome (face and tongue) • Less common tardive movement disorders • Tardive dystonia (twisting & bending) • Tardive chorea (looks like dancing) • Tardive tourettism (looks like Tourette) • Tardive tremor or myoclonus (the “shakes” or “jerks”) • Other tardive syndromes • Akathisia (restlessness) • Pain (oral or genital regions) • Respiratory irregularity

  4. An Example of Tardive Dyskinesia

  5. An Example of Tardive Dystonia

  6. What Causes Tardive Syndromes? • Neuroleptics • phenothiazines • butyrophenones • benzamides • “atypicals” 2. Antiemetics • metaclopramide • prochlorperazine 3. Antidepressants • tricyclics • SSRIs • lithium • Others • flunarizine • antibiotics

  7. Epidemiology of Tardive Syndromes 1. Prevalence is ~20% of chronically-treated patients • Incidence is ~5% per year during chronic treatment • Treatment duration is usually >3 months, often years • Susceptibility varies with age (older > younger) • Females outnumber males (~1.7 to 1) • Other risk factors: treatment duration, dose, brain injury, diabetes, mood disorder

  8. Treatment of Tardive Syndromes 1. Discontinue offending agent (if possible) • Other options that sometimes work • tetrabenazine, reserpine? • alternative neuroleptic? • vitamin E? • anticholinergics, benzodiazepines, baclofen? • calcium or beta blockers? • brain surgery? Tarvil? 3. Prevention

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