Tardive Dystonia Treated with Deep Brain Stimulation
Tardive dystonia (TD) refers to involuntary dystonic movements and postures which, like tardive dyskinesia (see Chap. 59), are due to the chronic use of dopamine receptor blocking agents (DRBAs) such as antipsychotic drugs and metoclopramide. Young adults appear to be particularly susceptible to this disorder. Although choreiform movements may occur, the principal feature of TD is dystonia which must be present for more than a month and occur either during ongoing treatment with DRBAs or within 3 months of its discontinuation. Dystonic movements in TD differ from classical tardive dyskinesia in several ways: (1) They typically involve axial muscles of the neck and trunk; (2) they tend to be more action specific, occurring intermittently with certain actions or postures and without exhibiting the more regular periodicity of classical tardive dyskinesia; (3) dystonic movements can sometimes be partially suppressed by simple sensory tricks; (4) unlike tardive dyskinesia, TD occurs more often among men than women.
KeywordsDeep Brain Stimulation Antipsychotic Drug Tardive Dyskinesia Axial Muscle Dystonic Movement
Tardive dystonia DBS.mp4 (MP4 14,141KB)
Clip 1: prior to DBS, the patient exhibits spasmodic retrocollis with synchronous jerks of the upper trunk. There is retraction of his jaw, facial grimacing, jaw clenching, and blepharospasm. Internal rotational dystonic movements are present distally in both upper extremities. Clip 2: four weeks after DBS, neck and trunk are now quiet, and there is no facial grimacing or upper extremity dystonia. There is mild retrocollis with eyes closed and arms extended.