Tardive Syndromes: A Challenging Multitude of Maladies

"Tardive syndrome" is an umbrella term for a group of drug-induced movement disorders associated with the prolonged use of mainly dopamine receptor blockers and also other medications. Early recognition followed by gradual withdrawal of the incriminating drug may lead to reversal, although not in all patients. Tardive syndromes are usually mixed movement disorders, with specific phenotypes, which may lead to severe disability. The pathophysiology remains incompletely understood. Treatment ranges from medical options, particularly dopamine-depleting agents and chemodenervation (botulinum toxin), to surgical options (deep brain stimulation and lesioning surgeries). Most studies that focused on treatment are limited by small patient numbers. Unfortunately, tardive syndromes often remain under-recognized in clinical practice. This article reviews the historical aspects, epidemiology and risk factors, pathophysiology, diagnostic criteria, clinical phenotypes, and management of tardive syndromes.