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  • tardive-dystonia
  1. About dystonia
  2. Types of dystonia
  3. Tardive dystonia

Tardive dystonia

Other names: Acute dystonia / Acute dystonic reaction 

Type: Focal

Tardive dystonia is a neurological movement disorder characterised by continuous or intermittent muscle contractions which cause abnormal, often painful, repetitive movements. It is a side effect of taking certain medication to treat other conditions.

There are several neurological movement disorders that result as side effects from medication. As a group, these are called tardive dyskinesias, and include facial tics and irregular, dance-like movements called choreas. Tardive dystonia is one type of tardive dyskinesia in which the involuntary movements tend to be slower and writhing.

In most cases, individuals will have an acute dystonic reaction / acute dystonia, where the symptoms tend to be acute but short-lived. Most of these acute reactions can be successfully treated with injectable anticholinergic medication which will usually end the episode.

Tardive dystonia is a more taxing condition as it can be permanent. Occasionally, symptoms do disappear but unfortunately this is rare (around 1 in 10 cases). Research suggests that, if the medication causing the tardive dystonia has been taken for only a short period of time, remission of symptoms is more likely than if the medication has been taken for a longer period.

What are the symptoms?

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Symptoms of an acute dystonic reaction include:

  • strange movements of the face and/or mouth
  • tongue protrusion
  • head tilts back
  • forced opening of the mouth
  • problems with eating and swallowing
  • eyes turned upward or to the side
  • hyper-extension of the spine

Symptoms of tardive dystonia include:

  • strange movements of the face and/or mouth
  • involuntary eye closure
  • voice problems
  • head tilts back
  • involuntary twisting or movement of the neck
  • contortion of the trunk
  • internal rotation of arms, elbow extension, wrist flexing
  • akathisia (feelings of inner restlessness)

Symptoms of focal dystonia can occur days or years after exposure to the medication.

Stress and anxiety are known to exacerbate the symptoms.

Published: 1st June, 2020

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Who does it affect?

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  • Tardive dystonia can affect at any age.
  • Tardive dystonia tends to progress in children to involve multiple body parts but remain focal to a specific body area in adults.
  • Acute dystonia is more common in younger patients compared to classic tardive dyskinesias.

Published: 2nd June, 2020

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What are the causes?

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Acute dystonic reaction and tardive dystonia are most commonly the result of side effects from a type of medication which is prescribed to treat schizophrenia and psychosis called a ‘dopamine receptor blocker’ (DRB). Some DRBs are also used to treat nausea and dizziness.

Many other medications have been reported to cause acute dystonic reactions including:

  • anti-depressants of the type that inhibit the reuptake of serotonin
  • calcium antagonists (sometimes used to treat high blood pressure and angina)
  • some anaesthetic agents
  • anticonvulsants such as carbamazepine and phenytoin
  • illicit drugs such as cocaine and ecstasy

Acute dystonia is more often associated with butyrophenone antipsychotics (e.g. haloperidol) compared to phenothiazine antipsychotics (e.g. prochlorperazine and chlorpromazine).

Acute dystonic reactions can occur within hours or days of exposure the medication or as a result in changes to the dose of medications while tardive dystonia usually occurs in patients who have been taking these medications for longer than 3 months.

Published: 3rd June, 2020

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What are the common treatments?

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The first step is usually a controlled withdrawal of the medication causing the problem. It is important this done under the supervision of a clinician. If it is important for the patient to continue taking DRB medication, then the clinician would be expected to look for different types of DRB medication that hopefully will not cause a further reaction.

Other treatments that are used include:

  • oral medication
  • botulinum toxin injections
  • deep brain stimulation

Published: 4th June, 2020

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How will it affect my life?

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You may need to find ways to adapt and might have to learn new ways to complete everyday tasks.

However, it is possible to live well with the condition and Dystonia UK is here to support you through all stages including initial onset, diagnosis, finding treatment and beyond.

Some people find their symptoms may respond to sensory tricks.

Published: 5th June, 2020

Updated: 10th July, 2020

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Published: 6th June, 2020

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