Tardive dyskinesia: Etiology, risk factors, clinical features, and diagnosis

Authors:: Andres Deik, MD, MSEd; Daniel Tarsy, MD
Section Editors:: Howard I Hurtig, MD; Stephen Marder, MD
Deputy Editor:: April F Eichler, MD, MPH

INTRODUCTION

Tardive dyskinesia (TD) is a medication-induced hyperkinetic movement disorder associated with the use of dopamine receptor-blocking agents, including antipsychotic drugs and two antiemetic agents, metoclopramide and prochlorperazine. TD encompasses a wide range of abnormal, involuntary movements that often persist after discontinuation of the causative medication. TD can be irreversible and lifelong. The condition can be disfiguring and disabling, with major negative impacts on psychologic health and quality of life.

TD is a clinical diagnosis that requires vigilance and screening of all patients taking dopamine-blocking agents, and exclusion of other conditions associated with abnormal movements. TD is important to recognize, since early discontinuation of the offending drug may offer the best chance of recovery.

The clinical features and diagnosis of TD will be reviewed here. Treatment and prevention of TD and other drug-induced movement disorders are reviewed separately. (See "Tardive dyskinesia: Prevention, treatment, and prognosis" and "Medical management of motor fluctuations and dyskinesia in Parkinson disease" and "Drug-induced parkinsonism".)

DEFINITIONS

TD is a medication-induced hyperkinetic movement disorder caused by exposure to dopamine receptor-blocking agents, most often antipsychotic drugs, that persists for at least a month after discontinuation of the offending agent [1]. Dyskinesia encompasses a variety of involuntary movements and postures, including chorea, athetosis, stereotyped behaviors, dystonia, akathisia, tics, respiratory dyskinesias, and very rarely tremor.

The term "tardive," or late, differentiates TD from other medication-induced extrapyramidal symptoms (EPS) that usually appear either acutely or very soon after exposure to dopamine receptor-blocking agents and that resolve after the drug is discontinued. Whereas parkinsonism may arise while using a dopamine-blocking agent (in what is known as drug-induced parkinsonism), it should never be thought of as a tardive phenomenon. (See 'Other drug-induced movement disorders' below.)

Literature review current through: Jun 2022. | This topic last updated: May 26, 2022.

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