Treatment of tardive dyskinesia

Abstract

Tardive dyskinesia is an iatrogenic disorder caused by dopamine receptor blocking drugs in psychiatric and nonpsychiatric patients. The phenotype of the movements is quite variable with syndromes that include chorea, dystonia, stereotypies, akathisia, and tics. The disorder is, for a majority of patients, permanent. There are now two treatments that are FDA approved, VMAT2 inhibitors valbenazine and deutetrabenazine. For those who require a different treatment, several medications have been examined in randomized trials for classical TD and may be reasonable choices in treatment. They include amantadine, levetiracetam, clonazepam, propranolol, tetrabenazine, and ginkgo biloba. Other options include botulinum toxin and deep brain stimulation surgery. An algorithm is provided.