Many people suffer from movement disorders, where they experience uncontrollable involuntary and repetitive movements in one or more parts of the body. These movements manifest as shakes, jerks, twitches, tics, twists, or forward/backward sways. Tardive dyskinesia is one such movement disorder that can affect a person for a long or short term. It develops rapidly and then either stabilizes or deteriorates. Below is a quick overview of the condition’s causes, symptoms, and management options

Definition of tardive dyskinesia
Tardive dyskinesia is characterized by unusual, uncontrollable, and repetitive movements in one’s face, torso, jaws, eyes, arms, or legs. While it can affect anyone, the risk is higher in older adults, especially those being treated for mental health conditions.

What causes the condition?
Our body produces dopamine, a hormone associated with pleasure, motivation, and satisfaction. Dopamine also controls neural functions like memory, concentration, learning, and movement. Long-term use of specific treatments prescribed for psychological, neurological, and, in some cases, gastrointestinal diseases can alter the dopamine levels in the brain. As a result, changes can occur in the neurons that control movement, leading to tardive dyskinesia.

Treatments for depression, Parkinson’s disease, seizures, bipolar disorder, schizophrenia, and psychosis are commonly known to trigger the condition. While not all patients being treated for these conditions get affected, the risk is high. The risk is also high for persons being treated for dementia and specific developmental issues. Usually, the symptoms appear only after patients have used the treatment for many years. However, the signs may sometimes manifest as early as three to six months after starting treatment.

What are the symptoms?
The common early warning signs and symptoms of tardive dyskinesia include:

• Smacking of the lips and tongue
• Uncontrolled sticking out of the tongue
• Twisted grimace-like expression
• Forward or backward bending of the torso
• Twisting of the torso
• Moving the arm rapidly in one or more directions
• Continuous or repetitive chewing
• Disturbed or impaired blinking
• Fluttering of the fingers
• Tapping of the toes

The intensity of the symptoms varies from person to person and can be short-term or permanent, intermittent or continuous. The symptoms are usually disabling, restrictive, and painful and affect the patient’s ability to perform daily activities.

How is the condition diagnosed?
When a doctor prescribes a treatment that can cause tardive dyskinesia, they counsel the patient and their caregivers about the risks and potential side effects and ask them to be vigilant of sudden movement changes. If someone returns with symptoms, doctors observe them and note any movement changes in the mouth, face, shoulders, hips, arms, extremities, and trunk. They then rank the symptoms to determine their severity.

The doctor may also prescribe blood examinations and brain scans to rule out other diseases, such as:

• Cerebral palsy
• Huntington’s disease
• Parkinson’s disease
• Stroke
• Tourette’s syndrome

Doctors may confirm tardive dyskinesia and begin treatment immediately if these conditions are met:

• The patient has been experiencing one or multiple symptoms for about a month
• They have been exposed to high-risk treatments for at least three months

How is tardive dyskinesia managed?
While the condition cannot be cured, treatment can ease the symptoms and improve one’s quality of life. The various treatment and management options are discussed below:

Adjusting treatment dosage
Tapering the treatment that causes tardive dyskinesia and eventually discontinuing it may help control the symptoms. The doctor may recommend a new treatment for the underlying mental health or neurological issue. If there are no alternatives that reduce the risk of tardive dyskinesia, the expert may adjust the dosage and timing of intake. They may also advise the patients to follow the regimen strictly.

Deep brain stimulation
Doctors may consider deep brain stimulation if a person becomes resistant to treatments or their symptoms become severe and disabling.

Assistive devices
Doctors also advise patients to use devices that can assist them in carrying out their daily activities. Some tools that can help patients with this movement disorder include:

• Weighted pens with thick and padded grips
• Electric jar openers
• Electric toothbrushes
• Cut-resistant gloves
• Mugs and cups with weighted handles
• Mugs with straws and lids

AIMS
Doctors use an assessment tool called the Abnormal Involuntary Movement Scale (AIMS) to detect tardive dyskinesia and monitor its progress over time. Sometimes, doctors use the tool as a reference when prescribing treatments that can cause the condition.

In addition to the above, doctors may recommend treatments to reduce the level of dopamine in the brain and control the movements. They may also prescribe treatments to reduce pain for those who experience contractions and spasms.