Tardive Dystonia: Causes, Symptoms, Treatment, Diagnosis

There are many movement disorders one of which is Tardive Dystonia which chiefly occurs as a result of a reaction to some specific prescription drugs. In tardive dystonia, the characteristic symptom experienced by the patient is involuntary contractions of the muscles, contorted movements of the body and awkward postures; all of which become painful and embarrassing for the patient.¹ The general meaning of dystonia is any movement disorder, which causes involuntary contraction and spasm of the muscles. These contractions commonly occur due to improper neurological functioning mechanism, the primary function of which is to help relax the muscles. The meaning of Tardive is “delayed,” and is in reference to the fact that there is a delayed onset of this disorder. Patient can develop tardive dystonia gradually while he/she is taking the offending medication or after treatment has ended with that particular medication.

The spasms related to tardive dystonia typically start in a single localized region of the body, such as the neck or face. As there is progression of this condition, these spasms tend to become more widespread. Tardive dystonia is similar to and can be misdiagnosed for other movement disorders, such as tardive dyskinesia. These two conditions can coexist and can also overlap; however, the movements of tardive dystonia are often slow and twisting; whereas the movements of tardive dyskinesia are rapid and jerky. Both these movement disorders can be a great source of embarrassment and social withdrawal for patients

Certain anti-psychotics are responsible for drug-induced tardive dystonia, especially the older medicines. Tardive dystonia can be exacerbated due to the use of other medications, such as medicines used for treating other movement disorders like Parkinson’s disease

Facial muscles are commonly involved in tardive dystonia; however, this condition can be widespread and be more generalized and affect other parts of the body as well. Symptoms depend on the area of the body where they occur and are characterized accordingly. Some of the common symptoms of tardive dystonia are:

• Blepharospasm is a condition which affects the muscles, which control the contractions of the eyelid and comprise of movements, such as prolonged blinking. Blepharospasm can lead to vision problems and decreased ability to perform daily tasks, such as reading or driving.
• Spasmodic torticollis is a symptom where there is contraction of the neck muscles causing the head to pull down resulting in an uncomfortable and abnormal posture. Spasmodic torticollis is the most painful type of tardive dystonia movement disorder.
• Diurnal bruxism is a symptom which causes forceful and rhythmic contractions of the jaw muscles and also cause teeth grinding when the patient is awake (and not during sleep). In this symptoms, patient experiences severe pain and considerable tooth damage.
• Ballismus causes involuntarily jutting of the arms or legs from the body. These movements can also be mistaken as a sign of aggression.
• Dysphonia is a symptom, which involves the muscles used in speaking and breathing. Dysphonia commonly causes difficulty in speaking and the patient tends to speak with a raspy and strangled voice and sound as if they are breathless.

There is gradual development of symptoms of tardive dystonia and they often are not immediately apparent to the patients and they are unaware that they are dealing with a serious movement disorder, which makes it difficult in diagnosing this condition. There is no single test which helps in diagnosing tardive dystonia. The patient’s movements are carefully monitored at different intervals to determine if they are involuntary and if they worsen or improve over the time. Patients should also keep a diary of their symptoms making note of the location, duration and severity of their movements.

• As of now, tardive dystonia has no cure. Treatment can be done to manage the symptoms of Tardive Dystonia using various prescription drugs and natural remedies.
• If the patient experiences symptoms of tardive dystonia and believes he/she is suffering from this condition, then they should seek immediate medical treatment. However, it is also important that the patients do not stop the prescribed medications and without consulting their doctor and should stay on them.
• Stopping the offending drug or changing to another atypical anti-psychotic medicine also helps in halting or reducing the symptoms. The offending medicine should be gradually stopped with a controlled withdrawal of that particular drug. If necessary, the medicine can be replaced with other class of antipsychotics such as olanzapine or clozapine.
• Other medicines depend on individual to individual and include drugs, which are used to treat dystonia, such as anticholinergic drugs like trihexyphenidyl or baclofen. Patient can experience sleepiness as a side effect of this drug and should consult with their doctor regarding this.
• Botulinum toxin (Botox) injections also can help in managing the involuntary movements in one or more localized areas. Which treatment will work for which patient cannot be predicted.
• Deep Brain Stimulation (DBS) is a treatment option which can be done when other treatments are not effective. This procedure comprises of implantation of electrodes into the brain so that patient can have ‘rebalance’ movement and is able to control his/her posture. The electrodes which are placed are powered by a battery which is implanted in the chest.
• Patients should also consult with a movement disorder specialist after consulting their physician for other treatment options.

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