Prevention/treatment of tardive dyskinesia

Tardive dyskinesia (TD) is a syndrome of involuntary hyperkinetic movement associated with long-term neuroleptic treatment. The syndrome depends on 1. predisposing factors, especially high age and an unknown constitutional vulnerability, and 2. a postsynaptic dopamine receptor hypersensitivity and/or a cholinergic hypofunction developed during prolonged antidopaminergic (neuroleptic) treatment. TE is easily kept in check by continued and intensified neuroleptic treatment, which on the other hand presumably involves an aggravation of the underlying pathological process. On this account the importance of prevention can hardly be exaggerated. The most important prophylactic measures are: 1. narrowing the field of indications for the use of neuroleptics, 2. taking particular measures in predisposed subjects, 3. limiting the antidopaminergic influence by the use of neuroleptics with slight striatal antidopaminergic effect, lowest possible dose, shortest possible time of treatment, as well as increased intervals, and 4. paying close attention to the possible development of TD (early detection). The significance of anticholinergics is still not clarified. Apparently anticholinergics accentuate TD at the time of treatment, with contributing to the development of the underlying primary defect.