Tardive dyskinesia

Tardive dyskinesia is a drug-induced movement disorder in which sudden, uncontrollable movements happen in the face and body because of prolonged use of medication, typically anti-psychotic drugs. “Tardive” means delayed, and “dyskinesia” means abnormal movement.

Tardive dyskinesia affects over 500,000 people in the United States. Females (especially post-menopausal women), older adults, and people of African descent have a higher risk of developing tardive dyskinesia.

Tardive dyskinesia symptoms usually develop after you’ve taken a medication for months or years. Some people can develop the condition after as little as six weeks, but this is less common.

The condition causes different kinds of uncontrolled movements in the face, arms, legs, or torso.

Abnormal facial movements may include the following:

• Blinking eyes rapidly
• Chewing motions
• Frowning or grimacing
• Grunting
• Puffing out cheeks
• Smacking or puckering lips or making a sucking noise with the mouth
• Sticking out the tongue or poking it into the inside of the cheek

Abnormal movements affecting the arms, legs, or torso may include:

• Rocking the pelvis back and forth
• Swaying from side to side
• Tapping the feet
• Waddling movement when walking
• Wiggling or tapping the fingers (as if playing the piano)

In rare cases, tardive dyskinesia may affect breathing or cause the eyes to stick in a certain position (usually looking upward). Both of these symptoms require immediate treatment.

Long-term use of medications that block the activity of the chemical messenger (neurotransmitter) dopamine in the brain can cause tardive dyskinesia. These medications are used to treat psychiatric conditions, nausea, seizures, and other conditions. Experts do not yet know why these medications cause tardive dyskinesia in some people, while other people have no problems.

General groups of medications that can cause tardive dyskinesia include:

• Neuroleptics (also known as anti-psychotics) used to treat psychiatric conditions, especially older versions of the drugs
• Certain anti-depressants and mood stabilizers
• Certain anti-nausea medications
• Certain anti-seizure medications
• Decongestants, such as pseudoephedrine and phenylephrine
• Medications for movement disorders
• Levodopa (used to treat Parkinson’s disease)

Penn Medicine specialists carefully review your medication history and check for the involuntary movements you may be experiencing. They also use a standardized tool called the Abnormal Involuntary Movement Scale (AIMS) to assess the type and severity of these movements. To tell tardive dyskinesia apart from short-term medication side effects, doctors look for symptoms that last at least a month after lowering or stopping the suspected medication. Because there’s no single test for tardive dyskinesia, your doctor will also make sure the movements aren’t caused by another condition.

Caring for people with tardive dyskinesia means managing multiple conditions at the same time. At Penn Medicine’s Movement Disorders Center, we treat more people with tardive dyskinesia than any other program in the region. Our expert team has the skill and experience necessary to safely relieve symptoms of tardive dyskinesia without compromising care for other conditions.