Tardive Dyskinesia

运动障碍是面部的非自愿运动（包括嘴唇，，，，tongue，，，，眼睛s), trunk, and extremities, which are identifiedinpatients who have been treated with certain (多巴胺-对手）药物。

Dyskinesias are difficult tocontrol。Many different conditions can lead to dyskinetic movements, including风湿热，，，，遗传disorders, or unusual disorders such as发动机tics and paroxysmal nonkinesigenic运动障碍。运动障碍运动可以包括眼睛blinking or closure,mouth打开或唇追捕，非自愿的舌头运动，或者肢体或躯干的更明显的运动。有时，运动障碍运动可能包括持续异常postures; in these cases, the movements are called肌张力障碍。

Tardive dyskinesias are a subgroup of dyskinesias that occur after exposure to certain types of medication. The most common medications that can lead to tardive dyskinesia includeantipsychotic用于治疗的药物和药物chronic恶心。这类药物通常用于治疗psychiatric诸如schizophrenia，，，，severedepressionor焦虑， 或者躁郁症。Often stereotyped, these drug-induced movement disorders include orofacial dyskinesias, or involuntary movements of the mouth, eyes, and tongue. The movements canrangefrom intermittent and infrequent to almost constant.

发展迟发性运动障碍的人数尚不清楚，但估计表明，大约5％-6％neurolepticoranti-nausea药物可能会出现症状；这个数字增加到大约25％的老年人口。有时，直到停止药物后才出现迟发性运动障碍（这称为戒断运动障碍）；其他人发现，他们的症状在重新开始药物或调整剂量后得到解决（这被称为“蒙面迟发性运动障碍”）。

虽然药物可以trigger迟发性运动障碍，迟发性运动障碍的根本原因或原因仍然未知。科学家推测，药物诱导的对特定区域的变化brain（多巴胺2或d-2受体）可能导致运动，但尚未证明这一理论。

虽然抗精神病药 - 包括第一代抗精神病药 -metoclopramide，，，，andantiemeticshave been implicated in the发作of tardive dyskinesia, the underlying cause remains unclear.

迟发性运动障碍的危险因素包括年龄，性别（年龄较大的女性更有可能出现迟发性运动障碍，而年轻的男性似乎更可能患上迟发性肌张力障碍），暴露于抗精神病药物，抗精神病药的剂量，抗精神病药的剂量cigarette smoking。

There are many different symptoms associated with tardive dyskinesia, including:

• Twisting movements of the tongue or tongue protrusion
• Lip pursing or smacking
• Grimacing
• 脸颊bulging or “puffing out”
• Chewing actions
• 闭眼

The facial movements may interfere with speaking or eating.

其他症状或体征包括：

• Involuntary actions of the hands orfeet，，，，including persistent finger movements or toeextension
• 肩膀shrugging
• 脖子movements (including pulling the head back or pushing it forward)
• 摇摆活动
• 髋关节运动
• 在极少数情况下，不规则breathing

迟发性运动障碍的常见症状

• 无意识的面部动作,尤其是舌头公关otrusion. In some cases, the tongue movements are so pronounced that the person’s tongue begins to grow, exacerbating the problems with protrusion.
• Lip pursing and grunting also are frequently identified in cases of tardive dyskinesia.
• 有时，患有迟发性运动障碍的人似乎会咀嚼某件事。

当人分心时，运动通常会更糟。但是，如果受影响的人意识到动作，他或她通常能够停止或减少活动。

When patients develop sustained twisting or abnormal postures related to medication use, a diagnosis of tardive肌张力障碍may be made.

Akathisia是一个senseof pronounced restlessness and an inability to sit still. People with akathisia will often pace, fidget, or march for hours on end. Unlike tardive dyskinesia, which occurs after several months or years of treatment, akathisia may arise after a single dose of a medication. Akathisia may be described asacute，开始服药后不久发生，发生在开始药物后数月或几年。

精神科医生和神经科医生，尤其是那些专门治疗运动障碍的人，在治疗迟发性运动障碍方面最有经验。

谨慎后诊断出迟发性运动障碍clinicalexamination and assessment of apatient’s history.Healthcare professionals consider and exclude other movement disorders, including drug-induced movement disorders, prior to making a diagnosis of tardive dyskinesia.

迟发性运动障碍是一种临床诊断，这意味着没有血tests,X-rays， 或者other客观的assessments which can confirm thiscondition。Physicians often use the Abnormal Involuntary Movement Scale (AIMS) to quantify movements, which appear to be tardive dyskinesia. This scale is a numeric score that grades involuntary movements from 0-4 in 10 different areas, including muscles of facial expression, lips/perioral area,颚，舌头，上肢，下肢，颈部，肩膀，臀部，整体运动的严重程度以及对运动的意识。许多消息来源表明，接受抗精神病药物治疗的患者在开始治疗前和此后每3个月进行评级。

Health care professionals consider conditions such asthyroid disorders，，，，parathyroid conditions,Sydenham chorea，，，，syphilis，，，，威尔逊病，，，，and Meigesyndrome（（特发性orofacial dystonia) prior to making a diagnosis of tardive dyskinesia, as treatment is much different in those conditions.

Treatment of tardive dyskinesia is often difficult; in some cases, symptoms may escalate if a medication is stopped abruptly. Although discontinuation of the drug thought to be the cause of tardive dyskinesia is suggested followed by a trial of an alternate antipsychotic agent, this is not always a feasible solution for patients, and sometimes stopping the current antipsychotic medication may加剧the symptoms.

• 多巴胺耗尽药物 - 包括四苯甲嗪，葡萄苯甲嗪，，，，valbenazine，，，，and休闲- 所有这些都可以帮助缓解迟发性运动障碍的症状。尽管四苯甲嗪已被用于治疗迟发性运动障碍，但尚未收到FDA批准此申请。葡萄苯甲嗪和谷替嗪是FDA批准的药物，可治疗迟发性运动障碍。
• Benzodiazepinesmay be of benefit for some patients.
• 肉毒杆菌毒素注射可能有助于某些症状，例如blepharospasm或孤立的肌张力障碍。

Some patients have successfully usedGinkgo bilobafor control of their tardive dyskinesia. Researchers evaluatedvitamin E，，，，but found it to be ineffective.

许多患者可以治疗甚至逆转迟发性运动障碍。早期鉴定和治疗这种情况通常在控制症状方面最成功。

The most effective strategy in controlling tardive dyskinesia is预防;这包括s short-term use of antipsychotic medications and regular assessment of whether patients need to remain on the medication. Experts recommend that use of metoclopramide be limited to less than 3 months.

研究研究的潜在好处pyridoxine，以及试图量化incidence迟发性运动障碍正在进行中。可以在ClinicalTrials.gov上找到更多信息。