Tardive dyskinesia is a type of neurological disorder characterized by involuntary muscle movements, such as lip-smacking, tongue protrusion, and even grimacing. It also causes rapid involuntary arms, legs, trunk, and finger movements. It is estimated that almost 500,000 people suffer from tardive dyskinesia in our country. Out of these, at least 60 percent cases are mild, while only 3 percent are severe. Let us discuss its causes, symptoms, and treatment options.

Causes and risk factors
Tardive dyskinesia is caused due to long-term use of antipsychotic or neuroleptic medications for treating mental illnesses, such as dementia, schizophrenia, and bipolar disorders. These medications are generally used for treating psychiatric, neurological, and even gastrointestinal disorders that block the reception of dopamine.

Dopamine is a chemical messenger or a neurotransmitter present in the brain that is associated with the feeling of pleasure. It is also responsible for motor control. Tardive dyskinesia causes an imbalance in this chemical transmitter, which results in loss of motor control, hence the involuntary muscle movements. Other medications that could worsen the symptoms of tardive dyskinesia include anti-nausea medications, antidepressants, and antihistamines. It has been observed that using these medications for more than three months usually increases the risk of suffering from this neurological disorder.

People who are 55 years and older stand a higher risk of suffering from tardive dyskinesia. This is because there is a loss in motor control with age. Hence, it is recommended to administer lower doses of medication for a short duration to treat certain mental health conditions. Exhibiting symptoms such as twisting movements, tremors (shaking), and restlessness can increase the risk of suffering from tardive dyskinesia. Substance abuse and electroconvulsive therapy also increase the risk of suffering from the neurological disorder.

Symptoms
People suffering from tardive dyskinesia usually experience the mouth’s involuntary movements, such as frowning, grimacing, puckering, sticking out tongue, and lip-smacking. They might also not be able to control rapid body movements in the arms, legs, and trunk. Some patients develop distinct facial features such as drooping of the mouth and rapid blinking. Few people suffering from tardive dyskinesia might exhibit severe symptoms, such as difficulty breathing, swallowing, and even speaking.

Diagnosis
Doctors usually diagnose tardive dyskinesia by observing the timing of symptoms that developed after using certain medications. Most of the symptoms develop at least one month after stopping the medicines. However, if the symptoms start appearing six months after stopping the medications, it might be due to a different neurological disorder.

Conducting certain neurological examinations, such as evaluating thought processes, observing muscle tone and movements, and facial features, can also help diagnose the neurological disorder. Doctors might also perform blood tests to check if the liver and thyroid gland are functioning properly. Imaging tests, such as MRI (magnetic resonance imaging), might also be required to rule out other possible causes of symptoms.

Treatment
The first step toward treating tardive dyskinesia is stopping the medications that are causing the symptoms. This might suffice for treating mild symptoms of the neurological disorder. However, it is necessary to consult a doctor before stopping or making any changes in the ongoing medications. Other treatment options include the following:

• Alternate medications
  Certain medications, referred to as vesicular monoamine transporter 2 inhibitors can provide relief from tardive dyskinesia symptoms. These medications reduce the brain’s capacity to store dopamine. Medications containing benzodiazepine tetrabenazine and valbenazine can also help in easing the symptoms.

  Some doctors might suggest second-generation antipsychotics that have a reduced risk of causing tardive dyskinesia. Botulinum toxin or botox might also be recommended to relax and control abnormal movement of muscles.

• Brain simulation
  This treatment involves implanting electrodes in certain areas of the brain that control bodily movements. Transmitting small electrical impulses using these electrodes can affect the secretion of dopamine, thereby controlling the tardive dyskinesia symptoms. The amount of simulation can be controlled by placing a pacemaker-like device under the upper chest’s skin.

It is essential to pay attention to any new neurological symptoms that the patient might be experiencing. Early diagnosis can help control and treat the symptoms without any adverse side effects. Make sure to consult a neurologist before making any changes in medications to avoid side effects.