Tardive dystonia is the result or an abnormal response to certain medications that have been taken and is characterised by involuntary movements. Certain drugs have been implicated in causing dystonic reactions or dystonia. This form of dystonia is referred to as drug-induced dystonia. Some drugs may not cause dystonia but may aggravate the pre-existing disorder.
Click here for an article on tardive dystonia which appeared in our newsletter Tardive dystonia supplement Autumn 08.
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Since the 1950s, certain strong drugs have been widely used to treat serious mental health conditions such as schizophrenia or psychosis, and in many cases have been found to have a positive effect. These drugs may also be used for the treatment of some movement disorders such as sever chorea and tics. This family of drugs are called 'dopamine receptor blocking' drugs, or DRBs. There are by far the most common drug indicated as a cause of tardive dystonia.
Concerningly, DRBs are also prescribed for common conditions such as depression and anxiety. DRBs such as metoclopramide and prochlorperazine are commonly prescribed for the treatment of nausea and vertigo. One study suggests that over 20% of patients have been prescribed DRBs for conditions where alternative treatments might have been appropriate. It is generally accepted now that there are much better and safer alternatives to treating chronic nausea, dizziness and anxiety than the use of DRBs.
Acute dystonic reactions
Acute dystonic reactions to DRBs usually take place within a few days of the drug's first being administered. Typically this dystonia affects the oromandibular (jaw area,) and may cause hyperextension of the spine, among other effects. Treatment in these cases is clinically urgent, as serious consequences may result. Fortunately the majority of these acute reactions can be successfully treated with injectable anticholinergic drugs which will usually terminate the attack.
If it is necessary for the patient to continue taking DRB drugs, then the physician would be expected to explore different types of DRB drugs, i.e. newer versions which will hopefully not cause further acute dystonic reactions; including anti-depressants of the type that inhibit the reuptake of serotonin, calcium antagonists (sometimes used to treat high clood pressure and angina,) some anaesthetic agents, anticonvulsants such as carbamazepine and phenytoin and even illicit drugs such as cocaine and ecstasy.
Tardive dystonia / tardive dyskinesia
Tardive dystonia is caused only by DRBs, and usually only after individuals have taken the drugs for several months, or even years. It is a more challenging condition as it can be a permanent manifestation.
DRBs can also cause another non-dystonic movement disorder known collectively as tardive dyskinesia. The movements associated with this condition tend to be of the mobile 'fidgety' type in the facial area, while tardive dystonia usually produces strong spasms in the axial (trunk and neck) muscles, as well as arm and leg muscles.
Patients can have a combination of both disorders. There appears to be a greater chance of tardive dystonia in younger people, while onset and an older age is usually more associated with tardive dyskinesia.
The Dystonia Society is committed to ensuring that everyone with dystonia has access to the treatments they need, which includes raising awareness about dystonia in all its various forms. The Society is a good source of support and information for those who suffer from dystonia and their friends and families. We offer helpline services and regional support groups, a website full of information and resources (including an active forum,) and support research into treatment and practical methods of coping.
For more information, call our helpline on 0845 458 6322
Last reviewed January 2013
Disclaimer The Dystonia Society provides the information on this page as general information only. It is not intended to provide instruction and you should not rely on this information to determine diagnosis, prognosis or a course of treatment. It should not be used in place of a professional consultation with a doctor. The Dystonia Society is not responsible for the consequences of your decisions resulting from the use of this information, including, but not limited to, your choosing to seek or not to seek professional medical care, or from choosing or not choosing specific treatment based on the information. You should not disregard the advice of your physician or other qualified health care provider because of any information you receive from us. If you have any health care questions, please consult the relevant medical practitioner.