Tardive Dyskinesia Treatment and Risk Factors (AAN 2004)

Subject: Tardive Dyskinesia Treatment and Risk Factors (AAN 2004)

Date: 5/31/2004

E-MOVE reports from the American Academy of Neurology, San Francisco April 25-30, 2004. Page (A), session (S) and poster (P) numbers are from Neurology 2004;62(7), Suppl 5

1. Long-term tolerability of tetrabenazine in the treatment of hyperkinetic movement disorders
CB Hunter, KD Vuong, J Jankovic
P06.129, A506-507

Tetrabenazine remains effective for hyperkinetic disorders for many years, according to this report.

Long-term follow-up was conducted for 448 patients with hyperkinetic disorders treated with tetrabenazine (149 tardive dyskinesia, 132 dystonia, 98 chorea, 92 tics, 19 myoclonus). Mean treatment duration was 2.3 years, with a range from 0 to 22 years, at a mean dose of 60 mg/day. Efficacy remained stable for most patients throughout the treatment period. One third of patients discontinued, including for adverse events (17%) and lack of efficacy (9%). Rebound worsening occurred in some patients who discontinued. Most common adverse effects were drowsiness, parkinsonism, akathisia, and depression.

The full poster is available online at http://www.bcm.tmc.edu/neurol/jankovic/pdfs/TBZ_Tolerability_BW.pdf

2. Family history of primary movement disorders is a strong predictor for neuroleptic-induced EPS
M Kasten, G Eismann, I Koenig, C Klein, R Lencer
P06.127, A506

Patients with a family history of movement disorders are more likely to develop extrapyramidal symptoms when taking a neuroleptic drug, according to this study.

One hundred patients taking neuroleptics for at least one week were examined for presence of EPS, and interviewed for treatment history and details of family history. Treatment had been for less than 6 months in 38 patients, 6-60 months in 38 patients, and more than 60 months in 24 patients. EPS were more common in patients with a positive family history for movement disorders than in those with negative family history (p=0.041). Duration of typical neuroleptic treatment and age were also independently associated with risk for EPS. The authors suggest that family history should be considered when commencing therapy with neuroleptics.

3. Treatment of tardive dyskinesia by pallidal stimulation: Results from the French multicenter study STARDYS
P Damier, S Thobois, T Witjas, P Derkinderen, J Xie, JP Azulay, E Brousolle, P Burbaud, F Durif, O Rascol
P06.123, A504

Six patients with tardive dyskinesia received bilateral pallidal stimulation. Tardive symptoms included axial dystonia, orofacial dyskinesias, lower limb dystonia, and upper limb chorea. Symptomatic improvement occurred within several days, and by three months, there was a 50% improvement in the “TD score” (the sum of the tardive chorea and tardive dystonia subscales of the Extrapyramidal Symptoms Rating Scale). No changes in psychiatric state occurred as a result of treatment.

E-MOVE Editor: Richard Robinson, NASW, WE MOVE