Dyskinesia: Clinical Manifestations and Management

Introduction to Dyskinesia

Dyskinesia is a neurological disorder characterized by involuntary, abnormal, irregular, and purposeless movements that can affect various body regions, most commonly the orofacial area but potentially involving any body part 1

Tardive Dyskinesia (TD) is the most common form, associated with long-term use of dopamine receptor-blocking agents (primarily antipsychotics), characterized by choreoathetoid movements typically affecting the orofacial region, limbs, and trunk 1
Paroxysmal Kinesigenic Dyskinesia (PKD) is characterized by recurrent and transient attacks of involuntary movements (dystonia, chorea, ballism) precipitated by sudden voluntary actions, with episodes typically lasting less than 1 minute 2

Dyskinesias can manifest as dystonia (sustained muscle contractions causing twisting movements) 3
Dyskinesias can manifest as ballism (large amplitude, flinging movements) 3
Dyskinesias can manifest as athetosis (slow, writhing movements) 2
Tardive dyskinesia typically affects the orofacial region (70% of patients), causing facial twitching, rigidity of facial muscles, and dysarthria 3
In PKD, face involvement is reported in approximately 70% of patients 3
PKD attacks typically last less than 1 minute in over 98% of patients 3
PKD attack frequency varies significantly among individuals, ranging from several times a year to more than 100 times per day 3

PKD is often associated with genetic abnormalities, with proline-rich transmembrane protein 2 (PRRT2) identified as the first causative gene 2

If clinically feasible, gradually withdraw the offending antipsychotic medication for Tardive Dyskinesia 1
Consider switching to atypical antipsychotics with lower D2 affinity when antipsychotic treatment must continue for Tardive Dyskinesia 1
Some patients with PKD can alleviate attacks by slowing their movements when experiencing aura 3

Baseline assessment of abnormal movements before starting antipsychotic therapy is recommended 1
Regular monitoring using standardized measures like the Abnormal Involuntary Movement Scale (AIMS) every 3-6 months is recommended 1
Early detection is crucial as tardive dyskinesia may persist even after medication discontinuation 1

The concern over dyskinesia risk should be balanced against the potential benefits of necessary medications 1
Adequate informed consent regarding dyskinesia risk is necessary when prescribing medications with potential to cause movement disorders 1