Understanding What Sets Apart Tardive Dyskinesia and Parkinson’s Disease
People with tardive dyskinesia (TD) and people being handled for Parkinson’s illness could share related signs—specifically uncontrollable physique actions referred to as dyskinesias—however tardive dyskinesia and Parkinson’s illness are two very completely different diagnoses.
Tardive dyskinesia and Parkinson’s illness are each neurological circumstances that trigger motion problems, however have completely different causes and shows. Dyskinesias are a facet impact of medicines used to deal with Parkinson’s illness, whereas tardive dyskinesia is a complication of medicines typically used to deal with psychiatric circumstances.
The mind chemical dopamine is the widespread denominator linking these two circumstances. “Dopamine is a key transmitter in the brain that controls movement,” explains Alessandro Di Rocco, MD, a neurologist and motion dysfunction specialist at Lenox Hill Hospital in New York City. “If you have too little dopamine as in Parkinson’s disease, you experience slowness of movement, and if you have too much, as in TD, you have involuntary movements,” he says.
Doctors treat Parkinson’s disease mostly with a drug referred to as levodopa, which ends up in the discharge of dopamine and may trigger what’s generally known as levodopa-induced dyskinesia (LID).
What Is Tardive Dyskinesia?
The National Institute of Neurological Disorders and Stroke (NINDS) defines tardive dyskinesia as a motion dysfunction that causes a variety of repetitive and involuntary muscle actions within the face, neck, arms, and/or legs.
Tardive dyskinesia is a facet impact of a number of kinds of drugs, together with antipsychotic medication, often known as neuroleptics, used to deal with psychiatric circumstances corresponding to schizophrenia or bipolar disorder, nausea, or different circumstances, says Roy N Alcalay, MD, MS, an affiliate professor of medical neurology at Columbia University in New York City.
These medication could change dopamine signaling within the mind, leading to involuntary physique actions. Up to 25 p.c of people that take antipsychotic medication will develop tardive dyskinesia, Di Rocco says. “The first-generation antipsychotic drugs are more likely to cause TD.”
What Are the Symptoms of Tardive Dyskinesia?
According to the National Alliance on Mental Illness (NAMI), tardive dyskinesia is marked by uncontrolled muscle actions within the face (lip smacking, grimacing, eye blinking, tongue actions) and/or within the limbs (jerking hand and leg actions), neck twisting, or swallowing issues.
When Do Tardive Dyskinesia Symptoms Typically Start?
Tardive means late, thus tardive dyskinesia refers to late-onset dyskinesias. These signs can begin years or months after taking an antipsychotic remedy or drug that blocks the mind’s dopamine receptor, however there are occasions that tardive dyskinesia signs can come on as quickly as six weeks after beginning a brand new remedy. These signs could go away after an individual stops taking the remedy, however they’ll additionally persist, Di Rocco says.
How Is Tardive Dyskinesia Treated?
The technique is to attempt completely different medication which are much less more likely to trigger dyskinesias to deal with the underlying illness. While there are drugs used off-label to deal with TD, there are solely two drugs permitted by the United States Food and Drug Administration (FDA) for particularly treating tardive dyskinesia: valbenazine and deutetrabenazine.
These are a brand new class of medicine generally known as vesicular monoamine transporter 2 (VMAT2) inhibitors that assist regulate the discharge of dopamine, says Di Rocco.
It’s crucial that you just don’t cease taking psychiatric drugs with out first speaking to your physician. “You need to treat the underlying disorder, which may be more pressing than TD,” Alcalay says. Instead, work along with your physician to seek out methods to attenuate these dyskinesias by switching remedy, or if completely not possible to vary drugs, by including a VMAT2 inhibitor to scale back this facet impact.
What Is Parkinson’s Disease?
Parkinson’s illness is a neurodegenerative illness that happens when nerve cells within the space of the mind that controls motion turn out to be impaired and/or die. Normally, these nerve cells produce the feel-good mind chemical dopamine, however when they’re briefly provide, dopamine dwindles, and Parkinson’s illness signs happen, in response to the Parkinson’s Disease Foundation.
In a brand new examine printed December 15, 2022, within the journal npj Parkinson’s Disease revealed that the annual incidence of Parkinson’s illness within the United States amongst older adults is in reality 50 p.c greater than present estimates. The new incidence fee totals almost 90,000 diagnoses every year as a substitute of the earlier annual estimates of 60,000.
What Are the Symptoms of Parkinson’s Disease?
Parkinson’s illness tends to develop regularly over years, beginning with slowness, stooped posture, stiffness within the limbs, frailty, stability issues, and a tremor, explains Di Rocco, including that Parkinson’s illness sometimes begins round age 60. There are additionally Parkinson’s illness symptoms which are unrelated to motion, corresponding to despair, nervousness, apathy, hallucinations, sleep problems, lack of sense of odor, and bother with pondering and reminiscence.
“Parkinson’s disease and TD don’t look alike,” says Alcalay. “Parkinson’s disease starts with a slow, stooped posture and gait problems, but adding medications that work on the dopamine pathway can cause dyskinesias.”
Does Parkinson’s Disease Cause Dyskinesias?
Parkinson’s illness doesn’t trigger dyskinesias, however levodopa, one of many major drugs used to manage the signs of Parkinson’s illness, does, says Di Rocco. The majority of people that take levodopa will develop dyskinesias, however they aren’t that extreme for a majority of people, he says. “With Parkinson’s disease, the dyskinesias are drug-related and when the levodopa wears off, you don’t have dyskinesias anymore.”
These uncontrolled jerky actions have a tendency to begin after a couple of years of therapy with levodopa for Parkinson’s illness, Di Rocco says.
How Are Dyskinesias Treated in People with Parkinson’s Disease?
Neurologists have gotten a lot better at minimizing dyskinesias in folks with Parkinson’s illness. Most people with Parkinson’s illness want to be “on” with some dyskinesias quite than “off” and unable to maneuver, explains Di Rocco, including that docs now use decrease doses of levodopa to scale back the severity of involuntary actions.
Another drug, amantadine, (or the sluggish launch model of amantadine), could cut back dyskinesias in folks with Parkinson’s illness and could be added to a therapy routine. Deep mind stimulation (DBS) can also be a therapy choice for Parkinson’s illness and one which will deal with dyskinesias, Alcalay says.
How Can Doctors Tell If Symptoms Are Caused by Tardive Dyskinesia or Parkinson’s Disease?
People with tardive dyskinesia have a historical past of taking sure drugs. The key to understanding the reason for the dyskinesia is to take an intensive medical historical past,” Di Rocco says. Other clues embody age and symptom patterns. People with tardive dyskinesia are usually youthful than these with Parkinson’s illness, and they’re additionally extra more likely to have facial actions corresponding to lip smacking and blinking.
If an individual can’t give a dependable medical historical past, different checks could also be wanted to seek out the reason for the involuntary actions.
What Is Parkinsonism?
An umbrella time period for a gaggle of neurological problems that trigger motion issues much like these seen in Parkinson’s illness, parkinsonism is characterised by tremors, sluggish motion, and stiffness. It could be arduous to tease out whether or not an individual has Parkinson’s illness or parkinsonism early within the illness development (two completely different illnesses). Several problems trigger parkinsonism, and these signs have a tendency to return on faster than these related to Parkinson’s illness. Parkinsonism may additionally accompany such circumstances and signs as falling, dementia, or hallucinations. Alcalay says these problems often don’t reply nicely to levodopa, or in the event that they do, it’s just for a short time.
What Is Drug-Induced Parkinsonism?
Drug-induced parkinsonism could be troublesome to differentiate from the signs of Parkinson’s illness. It is often the facet impact of medicine that have an effect on dopamine ranges within the mind, corresponding to some antipsychotics, temper stabilizers, and drugs used to deal with nausea in these with gastrointestinal reflux illness. According to a 2022 paper in StatPearls, the chance of creating drug-induced parkinsonism will increase as an individual will get older, with most instances occurring in folks between the ages of 60 and 80.
How Do Drug-Induced Parkinsonism and Tardive Dyskinesia Differ?
Drug-induced parkinsonism signs corresponding to slowness, rigidity, and tremors can seem inside hours to weeks of beginning an antipsychotic remedy or upping the dose of an antipsychotic drug. By distinction, tardive dyskinesia onset is delayed and infrequently begins with involuntary, irregular facial actions corresponding to lip smacking, puckering, or chewing. Another distinction: Drug-induced parkinsonism resolves when an individual stops taking the drug that triggered the signs, which isn’t at all times the case with tardive dyskinesia.
An individual can have each circumstances, Alcalay says. “You can have drug-induced parkinsonism and tardive dyskinesia from antipsychotics,” he says.
How Do Doctors Treat Drug-Induced Parkinsonism?
You can swap drugs to at least one that’s much less more likely to trigger drug-induced parkinsonism. Some medication generally known as anticholinergic brokers can assist deal with drug-induced parkinsonism however could make tardive dyskinesia worse, so making the excellence is necessary.
Editorial Sources & Fact-Checking
- Kwon, Destany Ok. et al. Levodopa-Induced Dyskinesia in Parkinson’s Disease: Pathogenesis and Emerging Treatment Strategies. Cells. Nov. 2022.
- Tardive Dyskinesia: What Research Is Being Done? National Institute of Neurological Disorders and Stroke (NINDS).
- Tardive Dyskinesia. National Alliance on Mental Illness (NAMI).
- McEvoy, Joseph P. FDA-Approved Medications to Treat Tardive Dyskinesia. The Journal of Clinical Psychiatry. Dec. 2019.
- What Is Parkinson’s? Parkinson’s Foundation.
- Willis, A.W., Roberts, E., Beck, J.C., et al. Incidence of Parkinson Disease in North America. Npj Parkinsons Disease. Dec. 15,2022.
- Parkinson’s Disease: Causes, Symptoms, and Treatments. National Institute on Aging (NIH).
- Gandhi Ok.R., Saadabadi A. Levodopa (L-Dopa). StatPearls. Updated May 2, 2022.
- Parkinson’s Disease vs. Parkinsonism. Parkinson’s Foundation.
- Shrimanker, Isha, et al. Parkinsonism. StatPearls. Updated June 7, 2022.
- Ward, Ok.M., and Citrome L. Antipsychotic-Related Movement Disorders: Drug-Induced Parkinsonism vs. Tardive Dyskinesia—Key Differences in Pathophysiology and Clinical Management. Neurology and Therapy. Dec. 2018.
Originally posted January 24, 2023
Medically reviewed by Allison Young, MD
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