Tardive dyskinesias and other drug-induced movement disorders

SANTIAGO PEREZ-LLORET; MARCELO MERELLO

Uncommon causes of Movement Disorders.

Cambridge University Press.

Lugar: Cambridge; Año: 2011; p. 139 - 152

Abnormal involuntary movements or extrapyramidalreactions are common adverse events; though initiallydescribed aft er APD use, they have also been linked toother psychiatric or nonpsychiatric drugs such as serotonin-specifi c reuptake inhibitors, metoclopramide orsome calcium-channel blockers, among others [ 7 – 11 ].Accompanying symptoms and time to onset ofDIMDs vary signifi cantly and include parkinsonism aswell as motor restlessness (akathisia), dystonia and theentire spectrum of hyperkinesias (namely, chorea, stereotypies,myoclonus, dystonia and tics) [ 12 ]. Th ey can becategorized as acute (immediate), continuous (insidious)or persistent (tardive) ( Table 13.1 ) [ 13 ]. Dystoniarepresents the most important acute drug reaction,oft en intensifying so rapidly and to such a degree ofseverity that patients present directly to the emergencyroom and may require hospitalization. ContinuousDIMDs persist only while the off ending drug is beingadministered and remit aft er its discontinuation, eitherimmediately or a variable of time aft er discontinuation.Th ey include akathisia, tremor, parkinsonism, choreaand myoclonus. Finally, tardive syndromes consist ofa variety of DIMDs appearing long aft er the beginningof drug use. Typically, discontinuation of the off endingdrug will not relieve persistent DIMD [ 13 ].