Tardif Diskinezi için Güncel Tanı ve Tedavi Yaklaşımları

Öz

Tardif diskinezi (TD) sıklıkla orabukkal bölgede gözlenen ancak boyun, gövde ve ekstremiteleri de tutabilen, istemsiz ve tekrarlayıcı hareketlerden oluşan bir hiperkinetik hareket bozukluğudur. Farklı ilaçların TD oluşumuna yol açabildiği bildirilmiştir. Ruhsal Bozuklukların Tanısal ve İstatistiksel El Kitabının son baskısında (Diagnostic and Statistical Manual for Mental Disorders DSM-5) en az birkaç ay, nöroleptik bir ilaç kullanılmasıyla gelişen bir hareket bozukluğu olarak tanımlanmaktadır. Etiyolojisi net olarak belirlenememiştir. Patofizyolojisi için ortaya konulan farklı hipotezler ile ilişkili farklı tedavi yaklaşımları bulunmaktadır. Önerilen tedavilerin pek çoğunun kanıt düzeyi düşüktür. Tüm bu özellikler dikkate alındığında risk faktörlerini iyi bilmenin TD oluşumunu önleme açısından değerli olduğu sonucu çıkartılabilir. Ayrıca iyi bir ayırıcı tanı da erken müdahalede bulunulabilmesi için değerlidir. Bu yazıda pskiyatristlerin ve diğer hekimlerin TD konusundaki farkındalıklarını artırmak amacıyla tardif diskinezinin tanı ve güncel tedavi yaklaşımları gözden geçirilmiştir.

Anahtar Kelimeler

• Tardif diskinezi,tanı,tedavi

The Diagnosis And Current Treatment Approaches For The Tardive Dyskinesia

Öz

Tardive dyskinesia (TD) is a hyperkinetic movement disorder characterized by involuntary and repetitive movements, often seen in the orobuccal region, but also in the neck, trunk and extremities. Different drugs have been reported to induce TD formation. In the last edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is described as a movement disorder developed by the use of a neuroleptic drug for at least a few months. Ethiology could not be determined clearly. There are different treatment approaches related with the different pathophysiological hypotheses of the disease. Most of the recommended treatments are of low level of evidence. Taking into account all of these, it can be concluded that knowledge about the risk factors of the TD is valuable in terms of prevention of the disease development. Besides, an accurate differential diagnosis is also valuable for the early intervention. In this article, the diagnosis and current treatment approaches of TD were reviewed in order to increase the awareness of psychiatrists and other medical doctors about TD.

Anahtar Kelimeler

• Tardive dyskinesia,diagnosis,treatment

Kaynakça

1. 1.Schonecker M.Paroxysmal dyskinesia as the effect of megaphen. Nervenarzt. 1957;28(12):550-3.
2. 2.Faurbye A, Rasch PJ, Petersen PB, Brandborg G, Pakkenberg H. Neurological Symptoms in Pharmacotherapy of Psychoses. Acta Psychiatr Scand. 1964;40:10-27.
3. 3.Bhidayasiri R, Fahn S, Weiner WJ, Gronseth GS, Sullivan KL, Zesiewicz TA, et al. Evidence-based guideline: treatment of tardive syndromes: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;81(5):463-9.
4. 4.Waln O, Jankovic J. An update on tardive dyskinesia: from phenomenology to treatment. Tremor Other Hyperkinet Mov (N Y). 2013;3.
5. 5.Cornett EM, Novitch M, Kaye AD, Kata V, Kaye AM. Medication-Induced Tardive Dyskinesia: A Review and Update. Ochsner J. 2017;17(2):162-74.
6. 6.Kim J, Macmaster E, Schwartz TL. Tardive dyskinesia in patients treated with atypical antipsychotics: case series and brief review of etiologic and treatment considerations. Drugs Context. 2014;3:212259.
7. 7.Lerner PP, Miodownik C, Lerner V. Tardive dyskinesia (syndrome): Current concept and modern approaches to its management. Psychiatry Clin Neurosci. 2015;69(6):321-34.
8. 8.Lee HJ, Kang SG. Genetics of tardive dyskinesia. Int Rev Neurobiol. 2011;98:231-64.

9. 9.Demirkol ME, Şenbayram Ş, Doğangüneş G, Tamam L. Tardiv Diskinezi ve Tedavi Yaklaşımları. Psikiyatride Güncel Yaklaşımlar 2018;10(2):239-54.
10. 10.Kulkarni SK, Naidu PS. Pathophysiology and drug therapy of tardive dyskinesia: current concepts and future perspectives. Drugs Today (Barc). 2003;39(1):19-49.
11. 11.Stahl SM. Neuronal traffic signals in tardive dyskinesia: not enough "stop" in the motor striatum. CNS Spectr. 2017;22(6):427-34.
12. 12.Miller R, Chouinard G. Loss of striatal cholinergic neurons as a basis for tardive and L-dopa-induced dyskinesias, neuroleptic-induced supersensitivity psychosis and refractory schizophrenia. Biol Psychiatry. 1993;34(10):713-38.
13. 13.Rana AQ, Chaudry ZM, Blanchet PJ. New and emerging treatments for symptomatic tardive dyskinesia. Drug Des Devel Ther. 2013;7:1329-40.
14. 14.Lohr JB, Kuczenski R, Niculescu AB. Oxidative mechanisms and tardive dyskinesia. CNS Drugs. 2003;17(1):47-62.
15. 15.Teo JT, Edwards MJ, Bhatia K. Tardive dyskinesia is caused by maladaptive synaptic plasticity: a hypothesis. Mov Disord. 2012;27(10):1205-15.
16. 16.Caroff SN, Campbell EC, Carroll B. Pharmacological treatment of tardive dyskinesia: recent developments. Expert review of neurotherapeutics. 2017;17(9):871-81.
17. 17.Cloud LJ, Zutshi D, Factor SA. Tardive dyskinesia: therapeutic options for an increasingly common disorder. Neurotherapeutics. 2014;11(1):166-76.
18. 18.Association AP. Diagnostic and Statistical Manual of Mental Disorders. Arlington: VA: American Psychiatric Association; 2013.
19. 19.Schooler NR, Kane JM. Research diagnoses for tardive dyskinesia. Arch Gen Psychiatry. 1982;39(4):486-7.
20. 20.Citrome L. Reprint of: Clinical management of tardive dyskinesia: Five steps to success. J Neurol Sci. 2018;389:61-6.
21. 21.Margolese HC, Chouinard G, Kolivakis TT, Beauclair L, Miller R, Annable L. Tardive dyskinesia in the era of typical and atypical antipsychotics. Part 2: Incidence and management strategies in patients with schizophrenia. Can J Psychiatry. 2005;50(11):703-14.
22. 22.Citrome L. Tardive dyskinesia: placing vesicular monoamine transporter type 2 (VMAT2) inhibitors into clinical perspective. Expert review of neurotherapeutics. 2018;18(4):323-32.
23. 23.Citrome L. Valbenazine for tardive dyskinesia: A systematic review of the efficacy and safety profile for this newly approved novel medication-What is the number needed to treat, number needed to harm and likelihood to be helped or harmed? Int J Clin Pract. 2017;71(7).
24. 24.Hauser RA, Factor SA, Marder SR, Knesevich MA, Ramirez PM, Jimenez R, et al. KINECT 3: A Phase 3 Randomized, Double-Blind, Placebo-Controlled Trial of Valbenazine for Tardive Dyskinesia. Am J Psychiatry. 2017;174(5):476-84.
25. 25.Meyer JM. Forgotten but not gone: new developments in the understanding and treatment of tardive dyskinesia. CNS Spectr. 2016;21(S1):13-24.
26. 26.Claassen DO, Carroll B, De Boer LM, Wu E, Ayyagari R, Gandhi S, et al. Indirect tolerability comparison of Deutetrabenazine and Tetrabenazine for Huntington disease. J Clin Mov Disord. 2017;4:3.
27. 27.Citrome L. Deutetrabenazine for tardive dyskinesia: A systematic review of the efficacy and safety profile for this newly approved novel medication-What is the number needed to treat, number needed to harm and likelihood to be helped or harmed? Int J Clin Pract. 2017;71(11).
28. 28.Guay DR. Tetrabenazine, a monoamine-depleting drug used in the treatment of hyperkinetic movement disorders. Am J Geriatr Pharmacother. 2010;8(4):331-73.
29. 29.Zheng W, Xiang YQ, Ng CH, Ungvari GS, Chiu HF, Xiang YT. Extract of Ginkgo biloba for Tardive Dyskinesia: Meta-analysis of Randomized Controlled Trials. Pharmacopsychiatry. 2016;49(3):107-11.
30. 30.Pedroso JL, Henriques Aquino CC, Escorcio Bezerra ML, Baiense RF, Suarez MM, Dutra LA, et al. Ginkgo biloba and cerebral bleeding: a case report and critical review. Neurologist. 2011;17(2):89-90.
31. 31.Soares-Weiser K, Maayan N, McGrath J. Vitamin E for neuroleptic-induced tardive dyskinesia. Cochrane Database Syst Rev. 2011(2):CD000209.
32. 32.Sun CH, Zheng W, Yang XH, Cai DB, Ng CH, Ungvari GS, et al. Adjunctive Melatonin for Tardive Dyskinesia in Patients with Schizophrenia: A Meta-Analysis. Shanghai Arch Psychiatry. 2017;29(3):129-36.
33. 33.Miodownik C, Lerner V, Cohen H, Kotler M. Serum vitamin B6 in schizophrenic and schizoaffective patients with and without tardive dyskinesia. Clin Neuropharmacol. 2000;23(4):212-5.
34. 34.Libov I, Miodownik C, Bersudsky Y, Dwolatzky T, Lerner V. Efficacy of piracetam in the treatment of tardive dyskinesia in schizophrenic patients: a randomized, double-blind, placebo-controlled crossover study. J Clin Psychiatry. 2007;68(7):1031-7.
35. 35.Sirsi D, Safdieh JE. The safety of levetiracetam. Expert Opin Drug Saf. 2007;6(3):241-50.
36. 36.Woods SW, Saksa JR, Baker CB, Cohen SJ, Tek C. Effects of levetiracetam on tardive dyskinesia: a randomized, double-blind, placebo-controlled study. J Clin Psychiatry. 2008;69(4):546-54.
37. 37.Macerollo A, Deuschl G. Deep brain stimulation for tardive syndromes: Systematic review and meta-analysis. J Neurol Sci. 2018;389:55-60.
38. 38.Tschopp L, Salazar Z, Micheli F. Botulinum toxin in painful tardive dyskinesia. Clin Neuropharmacol. 2009;32(3):165-6.
39. 39.Beckmann YY, Secil Y, Saka S, Kuserli A, Ciftci Y. Treatment of intractable tardive lingual dyskinesia with botulinum toxin. J Clin Psychopharmacol. 2011;31(2):250-1.
40. 40.Jankovic J. An update on new and unique uses of botulinum toxin in movement disorders. Toxicon. 2018;147:84-8.
41. 41.Hatcher-Martin JM, Armstrong KA, Scorr LM, Factor SA. Propranolol therapy for Tardive dyskinesia: A retrospective examination. Parkinsonism Relat Disord. 2016;32:124-6.
42. 42.Vaddadi K, Hakansson K, Clifford J, Waddington J. Tardive dyskinesia and essential fatty acids. Int Rev Psychiatry. 2006;18(2):133-43.