With tardive dyskinesia (TD), prevention should be the first aim of the treatment team. This is done by using the lowest effective dose of neuroleptic drugs for the shortest amount of time necessary. If TD is diagnosed, the drug causing the problem is reduced in dosage or discontinued if possible. While TD may go away after withdrawal from a drug that causes it, sometimes the condition persists.
So far there is not a known cure for TD, but tardive dyskinesia treatment may involve drugs like Clozaril, which is in a class of drugs called “atypical neuroleptics.” Sometimes improvement is noted with use of high potency benzodiazepines like lorazepam, clonazepam, or diazepam.
While studies have been done on the use of natural substances like melatonin and vitamin E and B6, the results have been inconclusive. Vitamins that act as antioxidants are being investigated as well. With vitamins, studies have shown that they may be effective in preventing development of tardive dyskinesia, but they are not as effective as treatments once the problem has developed. Other new studies involving natural substances are being conducted with the so-called branch chain amino acids, but results have not been established yet.
Dopamine agonist drugs have also been tried, but their effectiveness has not be conclusively proven. An atypical neuroleptic drug called tetrabenazine has shown some promise in early studies. Treatment with drugs used to treat Parkinson’s disease, a movement disorder with symptoms that may look similar to those of TD, have actually been found to worsen it.
There may be cases where withdrawal from the drug causing tardive dyskinesia is not feasible, such as in cases of schizophrenia. Sometimes beta blockers are tried, but the results are hit or miss.
Treatment of more advanced cases of TD is more complex. Drugs may have to be withdrawn very slowly. While anticholinergic drugs may be helpful in some cases when TD is caught early, it may paradoxically make symptoms worse in cases where the condition has advanced.
In children, recognizing tardive dyskinesia is especially difficult. For example, in a child who is just learning to walk, a gait problem may not be apparent because of the wobbly nature of early walking. And physical restlessness or fidgeting in young children is common in perfectly normal children as well as those with TD.
When very young children develop TD, it can resemble cerebral palsy, and some symptoms of TD can easily be mistaken for a typical temper tantrum. Additionally, young children can’t articulate problems such as memory disturbances or headaches that may be due to the condition. Often pediatric movement disorder specialists need to examine a child in order to make a diagnosis of TD.
Beyond withdrawing children from drugs that may be causing symptoms of TD, treating the condition in children is difficult because children metabolize so many drugs much more different than adults do. The blood-brain barrier is undeveloped in children, so they are more susceptible to nervous system involvement due to drugs than adults. For these reasons, drugs known to cause TD are only used in children in rare cases, and only as a last resort.
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