Tardive means late onset and dyskinesia is a fluid involuntary aimless movement that is often continuously present. Late onset here means late in treatment with antipsychotics, often after months to years. Tardive dyskinesia can be divided into orofacial, limb-torso and respiratory dyskinesia.
Orofacial dyskinesia
This forms the core syndrome and is characterized by involuntary movements of the tongue, jaw, lips, or facial muscles. For example: worm-like movements of the tongue; bulging of the tongue in the cheek (bon-bon sign), chewingmovements, bulging of the lips, twitching in the face and frequent blinking.
Limb-trunk dyskinesia
This is characterized by dance-like involuntary movements of the torso and limbs. For example: fingers that move constantly (piano-playing fingers), irregular movements of the toes and even copulating movements of the pelvis.
Respiratory dyskinesia
Respiratory dyskinesia is characterized by frequent and irregular breathing. Sometimes it is also accompanied by noises, breathlessness, or shortness of breath. Respiratory dyskinesia is rarely isolated and usually accompanies orofacial dyskinesia. During sleep, the dyskinesia is gone. There is no specific (laboratory) test to confirm the diagnosis of tardive dyskinesia.
Movie
Dit is duidelijk voorbeeld van orofaciale dyskinesie gecombineerd met dyskinesie van de vingers. Er is voortdurend sprake van dyskinetische bewegingen van de tong die zo nu en dan ook uit de mond komt. Daarnaast zijn veel spieren rond de mond aangedaan wat zich uit in snoetjes trekken, openen en sluiten van de mond en kaakbewegingen. Ook de halsspieren zijn aangedaan. De handen zijn kort in beeld en bewegen dyskinetisch. Je hoort patiënte ook snel en onregelmatig ademhalen wat zou kunnen duiden op tevens aanwezig respiratoire dyskinesie.
Publicaties
1. Patel RS, Mansuri Z, Motiwala F, et al. A systematic review on treatment of tardive dyskinesia with valbenazine and deutetrabenazine. Ther Adv Psychopharmacol 2019; 9: 2045125319847882.
2. Sienaert P, van Harten P, Rhebergen D. The psychopharmacology of catatonia, neuroleptic malignant syndrome, akathisia, tardive dyskinesia, and dystonia. Handb Clin Neurol 2019; 165: 415-28.
3. Stegmayer K, Walther S, van Harten P. Tardive Dyskinesia Associated with Atypical Antipsychotics: Prevalence, Mechanisms and Management Strategies. CNS Drugs 2018; 32(2): 135-47.
4. Mentzel CL, Tenback DE, Tijssen MA, Visser-Vandewalle VE, van Harten PN. Efficacy and safety of deep brain stimulation in patients with medication-induced tardive dyskinesia and/or dystonia: a systematic review. J Clin Psychiatry 2012; 73(11): 1434-8.