Tardive dyskinesia and dystonia are both neurological disorders that can affect your muscles and cause involuntary muscle contractions.
Tardive dyskinesia, which is usually a side effect of some medications, may happen in about 20% of people who take those medications. Dystonia, which can occur for other reasons, affects about 250,000 people in the United States.
While their symptoms are similar, these conditions have several differences.
Tardive dyskinesia can lead to unusual patterns of muscle movement, including brief, jerky, involuntary movements that affect your face and mouth. The condition is triggered by prolonged use of certain psychiatric or other medications. The symptoms may continue even after you stop taking the medication.
With dystonia, different muscle groups may contract involuntarily. This can cause parts of your body to turn in unusual postures, like a twisted neck or a cramped hand. You might move in and out of these postures in a repetitive way, and you might have difficulty relaxing the muscles.
Here’s how the symptoms compare:
Symptoms of tardive dyskinesia vs. dystonia.
Design by Health
Tardive dyskinesia and dystonia differ primarily in their causes and when or how symptoms appear.
Their Causes
Tardive dyskinesia: Some people experience tardive dyskinesia after taking certain medications that block a brain chemical called dopamine. Specifically, it’s most common from older types of drugs used to prevent psychosis, such as Thorazine (chlorpromazine) or Haldol (haloperidol). These medications are typically used for psychiatric conditions such as schizophrenia or bipolar disorder.
Dystonia: Dystonia has more causes. Any of the following may cause dystonia:
- Inherited genetic diseases
- Later-onset neurological diseases, such as Parkinson’s disease
- Stroke
- Brain infection
- Drugs that block dopamine, either temporarily and suddenly (acute dystonia) or after long-term treatment (tardive dystonia)
A type of dystonia called idiopathic dystonia occurs without any known cause.
Improvement of Symptoms
Tardive dyskinesia: Symptoms often improve if you move the area intentionally, such as deliberately sticking out your tongue.
Dystonia: Symptoms of dystonia may get worse with intentional movement, and they may get better at rest. For example, you might get painful cramping in your hand when you try to write or involuntary contortions when you golf or play a musical instrument.
Timing of Symptoms
Tardive dyskinesia: The word “tardive” means “late.” Tardive dyskinesia doesn’t develop until you’ve been taking a medication that increases the risk for several months. The symptoms tend to come on gradually, and they continue after you’ve stopped the medication.
Dystonia: On the other hand, some types of dystonia come on fairly quickly. This may happen after a stroke, for example. Some people have dystonia symptoms that appear suddenly within a few days of taking a medication that blocks dopamine. This is sometimes called an acute dystonia reaction. It’s typically reversible once you stop taking that medication.
Affected Age Groups
Tardive dyskinesia: It can occur in anyone who takes dopamine-blocking drugs for a prolonged period, but children don’t take these medications very often. It can happen in younger adults, but older adults who take these medications are at highest risk.
Dystonia: It can occur in people of any age, including very young children. Different kinds of dystonia tend to show up at different ages.
Preventability
Tardive dyskinesia: You can work with your healthcare provider to help prevent tardive dyskinesia if your medication puts you at risk.
For example, newer antipsychotic drugs are less likely to cause the condition than older (first-generation) antipsychotics. These newer, less-risky drugs include medications like:
- Clozaril (clozapine)
- Abilify (aripiprazole)
- Seroquel (quetiapine)
- Latuda (lurasidone)
- Zyprexa (olanzapine)
It may help to talk to your healthcare provider about what drugs may help with the least risk. The lowest dosage that controls your symptoms may also be less likely to cause tardive dyskinesia. Some people may only need such medications temporarily, so it’s important to work with your prescriber to avoid taking them longer than needed.
Dystonia: You may not be able to prevent most causes of dystonia.
Tardive dyskinesia and dystonia overlap somewhat in some factors, including diagnosis, treatment approach, and complications.
Diagnosis
Both tardive dyskinesia and dystonia require ruling out other neurological issues, often with the help of a neurologist (a doctor specializing in the brain and nervous system). Other specialists like psychiatrists and ophthalmologists (eye doctor) may be needed to help eliminate other possibilities.
In general, no specific test can diagnose either condition, but a careful medical history and full neurological exam are essential. Sometimes, blood tests or brain imaging methods may be helpful to rule out other possibilities.
Treatment
While treatment methods can vary, sometimes healthcare providers use similar medications to treat either condition. For instance, medications sometimes used to treat dystonia and tardive dyskinesia include:
- Anticholinergic medications like trihexyphenidyl
- Dopamine-depleting drugs like Xenazine (tetrabenazine)
- Benzodiazepine drugs like Klonopin (clonazepam)
Other methods that may also be helpful for both conditions include injection with botulinum toxin, which helps your muscles relax, and deep brain stimulation, a type of surgical procedure.
Effect on Quality of Life
Living with tardive dyskinesia or dystonia can significantly affect your quality of life. Both may make it harder to perform everyday activities, maintain employment, get around easily, and socialize.
Rarely, both conditions can lead to life-threatening complications. For example, either condition may affect the vocal cords, muscles involved in breathing, or muscles involved in swallowing. In some cases, that might lead to a medical emergency.
Their Reactions Can Be Caused by the Same Medications
Tardive dyskinesia and acute dystonia reactions can be caused by some antipsychotic medications used for psychiatric issues. Less commonly, other kinds of drugs—including some antinausea drugs, antidepressants, and stimulants—can cause these conditions in some people.
Yes, it’s possible to have both tardive dyskinesia and dystonia. For example, someone who already has tardive dyskinesia might develop symptoms of dystonia after having a stroke.
Speak with a healthcare provider right away if you notice you or a loved one are having any unusual movement patterns while taking a dopamine-blocking drug, even if the changes are small. Stopping a drug when the first signs appear may prevent any symptoms from getting worse.
For signs of immediate distress, like difficulty breathing, it’s a good idea to call 911.
Tardive dyskinesia and dystonia are both neurological disorders affecting muscles and movement patterns. Tardive dyskinesia often causes repetitive, involuntary movements of the face, like lip smacking. Dystonia might cause symptoms like muscle contractions that put you into unusual postures, like a twist in your neck or hands.
A big difference between them is their causes. Tardive dyskinesia happens in some people after they’ve taken a dopamine-blocking drug for several months (most commonly for a psychiatric condition). Dystonia has many different causes, including genetic diseases, other neurologic conditions, brain injury, or a sudden response to a dopamine-blocking drug.
A similar approach can help diagnose both conditions. Neither can be cured, but medications and sometimes other procedures may help limit symptoms.
