Treating and Managing Tardive Dyskinesia

Tardive dyskinesia (TD) is a drug-induced involuntary movement disorder, generally of the lower face including the jaw, lips and tongue.^1,2 It can also affect the trunk and extremities. The term tardive means "delayed", and dyskinesia means "abnormal movement".¹ People with Parkinson’s disease (PD) are familiar with the feeling of uncontrolled movements. TD can affect those with or without PD or other movement disorders. The symptoms of tardive dyskinesia are brought on by the medications that are used to treat Parkinson’s and other conditions.

Medical dictionaries describe TD as involuntary, irregular, continuous, random and unpredictable, slow or fast movements that continue for a few weeks or more. The symptoms develop after taking neuroleptics, dopamine receptor blocking drugs (DRBD), for many months. TD may resolve and flare up over time or may be permanent. The likelihood of developing TD increases with age and medication dosage.

Tardive dyskinesia can also affect people being treated with antipsychotic medications. 20%-50% may experience TD. Older drug classes used to treat conditions such as depression, schizophrenia, and bipolar disorder can also trigger TD.

Parkinson's disease is a chronic, progressive movement disorder resulting from a depletion of dopamine due to cell damage or cell death in the substantia nigra area of the brain. Dopamine is a chemical in the brain needed for smooth, coordinated movement. The loss of dopamine can also cause slowness of movement, tremors, rigidity, and difficulties with balance.²

What does tardive dyskinesia (TD) look like?

TD looks like different, uncontrollable movements and patterns of the limbs and face. Sometimes referred to as stereotypy, the activity can be patterned, repetitive, and rhythmic movements that can involve one (simple) or more (complex) body parts. More than 3/4 of those with TD experience oral-facial-lingual stereotypic movements (OFL).¹ The Baylor College of Medicine Movement Disorders Clinic conducted a videotape review of 100 people with tardive dyskinesia. The evaluation showed that the majority experienced irregular and chaotic movements in the OFL region, including lip smacking, chewing and other tongue and mouth movements. Other areas of the body can also show signs of TD like nodding and rocking, repeated body movements like crossing and uncrossing arms and legs, and random vocalizations.

Those who experience these involuntary movements may not even realize it. Like other conditions, these stereotypies can get worse under stress. They can manifest as muscle contractions or spasms, inability to be still, facial tics, or other jerking and abnormal movements.

Cause of dyskinesia

TD is a complication of long-term drug use. In PD, people generally take levodopa, a medication which works by converting to dopamine in the brain.¹ It is difficult to continuously regulate these brain chemicals and fluctuating levels of dopamine are thought to play a role in onset of TD. High doses of levodopa and certain antipsychotics over extended periods of time can trigger TD.³

Dyskinesia management

TD can be persistent and irreversible.¹ Until recently there have been several limited treatment options for dyskinesia. One approach is to moderate levodopa dosage and frequency to minimize symptoms. Another path is to switch classes of medications; some newer medications reduce the rate of developing TD.⁴ Prevention, not taking levodopa medications until absolutely necessary, has been another method described in the literature and used by some. Making choices on medications and dosages along with your physician can help to regulate the effectiveness of the treatment while minimizing the side effects, including TD.

FDA approves Ingrezza

Ingrezza (valbenazine) capsules from Neurocrine Biosciences, is the first drug indicated for the treatment of adults with TD. Ingrezza is a VMAT2, a selective vesicular monoamine transporter 2 inhibitor that reduces the amount of dopamine released in the brain.² Taken once a day, Ingrezza regulates nerve signals that impact movement and motor function. Neurocrine reports that Ingrezza is considered a novel therapeutic because it selectively inhibits VMAT2 with no significant binding affinity for VMAT1, or other receptors. Ingrezza, like many medications, can have side effects such as somnolence (sleepiness), or QT prolongation (heart rhythm problems).² To find out if Ingrezza is right for you, talk with your physician about any other medications or supplements you may be taking.²

Tardive dyskinesia can be uncomfortable and embarrassing. Advances in pharmaceutical and brain research may continue to develop additional therapies to reduce or eliminate the abnormal, involuntary movements associated with TD.