Tardive Syndromes

Joseph H. Friedman, MD, FAAN, FANA p. 1081-1098 August 2019, Vol.25, No.4 doi: 10.1212/CON.0000000000000754
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PURPOSE OF REVIEW: This article reviews the history, nosology, clinical features, epidemiology, and treatment of tardive syndromes.

RECENT FINDINGS: The major advance in the field of tardive syndromes has been the development and US Food and Drug Administration (FDA) approval of two vesicular monoamine transporter type 2 inhibitors, valbenazine and deutetrabenazine, for treating tardive syndromes. These medications are derivatives of tetrabenazine and reduce dyskinetic movements by reducing dopamine stimulation. Treatment is not curative, and the medications reduce, or “mask,” symptoms but presumably without adding to the long-term risk of increased involuntary movements believed to accrue from suppressive treatment with dopamine receptor–blocking drugs. A confounding advance has been the accumulation of data finding that second-generation antipsychotics, also known as atypical antipsychotics, may not be safer than first-generation antipsychotics in causing tardive syndromes. The public health risk of tardive syndromes may actually have increased as some second-generation antipsychotics, widely promoted to both doctors and patients, are increasingly used as antidepressants.

SUMMARY: Tardive syndromes remain a public health risk. Second-generation antipsychotics have not been proven to have less risk than first-generation drugs in causing tardive syndromes and are nevertheless being used more widely to treat depression, bipolar disease, and insomnia. Symptomatic treatment for tardive syndromes is available, although expensive.

Address correspondence to Dr Joseph H. Friedman, 345 Blackstone Blvd, Butler Hospital, Providence, RI 02906, Joseph_Friedman@brown.edu.

RELATIONSHIP DISCLOSURE: Dr Friedman has received honoraria from Cambridge University Press, MedLink, and Springer Press. He has received research/grant support as site investigator of clinical studies for the Michael J. Fox Foundation for Parkinson’s Research and the National Institutes of Health.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Friedman discusses the unlabeled/investigational use of α-methyl-para-tyrosine, botulinum toxin, clozapine, deep brain stimulation, reserpine, and tetrabenazine for the treatment of tardive syndromes.

© 2019 American Academy of Neurology.