Fast Five Quiz: Movement Disorders

Helmi L. Lutsep, MD


July 08, 2021

Neuroleptic-induced tardive dyskinesia is characterized by choreiform, athetoid, and rhythmic movements of the tongue, jaw, trunk, and extremities. Diagnosis of neuroleptic-induced tardive dyskinesias generally requires symptoms that persist for 1 month after exposure to neuroleptics for at least 3 months. At least 1 month of exposure is typically required if the patient is aged 60 years or older.

Blepharospasm (repetitive, forceful, sustained contraction of the orbicularis oculi) may occur as an isolated finding. When it occurs in conjunction with dystonia of the lower face, jaw, and neck, it is referred to as Meige syndrome. Tardive blepharospasm is defined as the presence of repetitive sustained contractions of the orbicularis oculi that have lasted for at least 1 month and that developed during or within 3 months of the discontinuance of treatment with dopamine antagonists (in the absence of other disease or familial causes). Symptoms of tardive blepharospasm fluctuate. Fatigue, anxiety, work, and light exacerbate tardive blepharospasm, whereas rest and sleep relieve it.

Tardive dystonia occurs during long-term treatment with dopamine antagonists. It must be differentiated from acute dystonia, which occurs in the first days of neuroleptic treatment or after an increase in the dose. Tardive dystonia presents as fixed posturing of the face and neck (eg, anterocollis, retrocollis, torticollis), extremities, and trunk. It may be either localized, involving one or more body parts, or generalized. Unlike tardive dystonia, torsion dystonia is characterized by twisting and sustained contractions of muscles resulting in rapid, repetitive, distressing movements. Torsion dystonia usually begins with inversion of the foot and spasm of the proximal limb muscles, resulting in gait abnormalities. Scoliosis, torticollis, and tortipelvis may occur in torsion dystonia. Patients may experience considerable impairment in performing activities of daily living.

Tardive akathisia includes the presence of subjective symptoms of restlessness and the urge to move. It refers to the inability to sit down or remain still. People with tardive akathisia exhibit constant pacing and moving of the hands and feet. They typically shift their weight from one foot to the other when standing and swing their legs when sitting. It occurs as the dose of the dopamine antagonist is decreased after long-term treatment. People with akathisia complain of inner restlessness and the inability to remain still. Unlike other movement disorders, tardive akathisia can be diagnosed solely on the basis of the patient's subjective symptoms in the absence of any objective signs. The Hillside Akathisia Scale is often helpful.

Read more about the presentation of tardive dyskinesia.


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