Tardive dystonia and tardive dyskinesia are treated first by reviewing the causative medication with the psychiatrist and, where available, with medications for tardive dyskinesia; severe cases that persist are treated very effectively with bilateral pallidal deep brain stimulation (DBS).
In a meta-analysis of 117 patients, mostly with tardive dystonia and treated with GPi stimulation, dystonia scores improved by 76% and involuntary movement scores by 62% on average; the authors concluded DBS may be considered for severe, medication-resistant cases.[1] In a double-blind study of tardive dyskinesia, all ten patients improved, by 44% to 75%.[2]
Before surgery: the medication review
The first step is always a joint decision with the treating psychiatrist: whether the dose can be lowered, or the medication switched to one with lower risk, without endangering psychiatric stability. Never stop or change psychiatric medication on your own.
When is DBS indicated for tardive syndromes?
- Movements or postures are severe and disabling
- They persist despite medication changes and specific medications
- The psychiatric condition is stable
- The patient can take part in evaluation and follow-up programming
What results can be expected?
Tardive syndromes are among the best-responding indications for DBS in dystonia, comparable to primary dystonia.[1] Neck and trunk postures, such as retrocollis and trunk arching, and mouth and tongue movements all improve. Improvement often becomes clear within weeks to months.
Our approach
Our 25-member DBS team includes psychiatrists and psychologists. Every patient with a tardive syndrome is assessed by them before surgery, and we coordinate with the patient’s own psychiatrist at home throughout. More on tardive dystonia and tardive dyskinesia.
Frequently asked questions
Is DBS for tardive dyskinesia approved?
DBS for tardive syndromes is used in specialised centers on the basis of published studies and meta-analyses. Regulatory approval of the devices differs by country and indication; your team will explain the situation for you.
How fast does DBS work in tardive dystonia?
Many patients notice clear improvement within the first weeks to months; the full benefit can take longer.
Sources
- Macerollo A, Deuschl G. Deep brain stimulation for tardive syndromes: systematic review and meta-analysis. J Neurol Sci. 2018;389:55–60. doi:10.1016/j.jns.2018.02.013 Source
- Damier P, Thobois S, Witjas T, et al. Bilateral deep brain stimulation of the globus pallidus to treat tardive dyskinesia. Arch Gen Psychiatry. 2007;64(2):170–176. Source