A Case Report: Successful Management of Mixed Tardive Syndrome With Combination Pharmacotherapy in a 19-Year-Old...

A 19-year-old female with schizophrenia developed severe mixed tardive syndrome (choreoathetoid dyskinesia with prominent tardive dystonia) after antipsychotic treatment, which remained debilitating despite deutetrabenazine, benzodiazepines, baclofen, and amantadine. Over a 39-day inpatient stay, switching the antipsychotic to clozapine and adding botulinum toxin injections plus the central muscle relaxant eperisone led to dramatic improvement, with the Abnormal Involuntary Movement Scale (AIMS) score falling from 32 to 8. Her psychosis also stabilized (PANSS 70 → 44). At 2-month follow-up, the regimen was simplified with sustained benefit. This case illustrates that a multimodal strategy-combining a low-D2-affinity antipsychotic, a VMAT2 inhibitor, and targeted muscle relaxation-was associated with marked improvement in this patient with refractory mixed tardive syndrome. However, given the near-simultaneous implementation of multiple interventions, the relative contribution of each component cannot be definitively determined, and controlled studies are needed to establish the efficacy of this approach.