Tetrabenazine therapy of dystonia, chorea, tics, and other dyskinesias

Dopamine receptor blocking drugs, commonly used in the treatment of involuntary movements, may cause potentially serious adverse effects, including tardive dyskinesia. Tardive dyskinesia has not been reported with tetrabenazine, a dopamine-depleting drug. We report a follow-up in 217 patients treated with tetrabenazine for about 18 months (range, 1 to 80). The response was rated on a scale of 0 to 5 (1 = marked improvement, 4 = no response, 5 = worsening). The mean effect from tetrabenazine was rated as follows: 2.3 in 44 patients with tardive dyskinesia, 2.6 in 15 with tardive dystonia, 2.6 in 10 with Huntington's disease, 2.7 in 17 with Gilles de la Tourette's syndrome, 2.8 in 19 with generalized dystonia, 2.8 in 57 with Meige's syndrome, and 3.4 in 25 with other focal dystonias. Twenty-two patients with a variety of unusual movement disorders had a mean effect of 2.9. Parkinsonism occurred as a side effect in 53 patients, sedation in 28, depression in 23, anxiety in 16, insomnia in 11, and akathisia in 10. The choreatic movement disorders are most amenable to tetrabenazine therapy, but tardive and idiopathic dystonia may also be responsive. Tetrabenazine is an effective and relatively safe drug for a variety of hyperkinetic movement disorders.