TD is sometimes referred to as tardive syndrome, as it may present with several abnormal movements such as akathisia, athetosis, chorea, dyskinesia, dystonia, and tics, alone or in combination. In rare cases, tremor presents. These abnormal movements are most frequently observed in the mouth, lips, and tongue. Less frequently, the movements are seen in the limbs and trunk. Eating and swallowing may be disrupted, and in severe presentations, respiration may be affected.
Orofacial symptoms include protruding / writhing tongue, facial grimacing, sucking / smacking / pouting of the lips, chewing, cheek bulging, and blepharospasm. Limb and trunk symptoms include twisting and jerking fingers, foot tapping, shoulder shrugging, rocking, swaying, and hip thrusting. Opisthotonos (truncal and neck retrocollis) is a common form of TD. Limb and trunk movements are more commonly observed in children.
TD can persist after drug withdrawal for months or years. The condition can be exacerbated by abrupt withdrawal. Some patients are permanently affected.
Related topics: Drug-induced movement disorders, Drug-induced muscle spasm
G24.01 – Drug induced subacute dyskinesia
102449007 – Tardive dyskinesia
Differential Diagnosis & Pitfalls
- Huntington disease – Can have dystonia along with chorea, and may have had psychiatric symptoms treated with an antipsychotic. Query about family history of abnormal movements, psychiatric illnesses, or early departure from the family in a parent.
- Torsion dystonia – Retrocollis is much less common in idiopathic cervical dystonia than in TD.
- Oromandibular dystonias can appear very similar to TD. Look for more dystonia (jaw opening and closing or lateral deviation) in idiopathic oromandibular dystonia, and more persistent movement in TD.
- Neuroacanthocytosis – Can present with significant oromandibular dyskinesias.
- Parkinson disease – Dopamine receptor blockers also can produce some component of parkinsonism (drug-induced parkinsonism).
- Edentulous dyskinesia – Recent or even remote loss of teeth can trigger involuntary mouth movements, especially in the elderly.
- Tics – May involve oral movements. Look for vocalizations in Tourette syndrome.
- Psychomotor seizures – Look for any alteration of level of consciousness.
- Systemic lupus erythematosus
- Wilson disease
- Autoimmune or neoplastic channelopathies
- Neurodegeneration with brain iron accumulation (NBIA)
Drug Reaction Data