Tardive dyskinesia: Clinical features and diagnosis
- Daniel Tarsy, MD
Daniel Tarsy, MD
- Professor of Neurology
- Harvard Medical School
Tardive dyskinesia (TD) is a hyperkinetic movement disorder that appears with a delayed onset after prolonged use of dopamine receptor blocking agents, mainly the antipsychotic drugs (also called neuroleptics) and the antiemetic drug, metoclopramide.
TD has numerous clinical manifestations that include chorea, athetosis, dystonia, akathisia, stereotyped behaviors, and rarely tremor. The term "tardive" differentiates these dyskinesia from acute dyskinesia, parkinsonism, and akathisia, which appear very soon after exposure to antipsychotic drugs.
The clinical features and diagnosis of TD will be reviewed here. Other aspects of TD are discussed separately. (See "Tardive dyskinesia: Etiology and epidemiology" and "Tardive dyskinesia: Prevention and treatment".)
Manifestations of TD can include a variable mixture of orofacial dyskinesia, athetosis, dystonia, chorea, tics, and facial grimacing. The symptoms involve the mouth, tongue, face, trunk, or extremities. Tardive tremor has been rarely described [1,2].
Oral, facial, and lingual dyskinesia are especially conspicuous in older adult patients. These may include:
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