Meds can cause movement disorder
Dear Dr. Roach: I have a 67-year-old sister who has several medical issues. One of the more uncommon is called tardive dyskinesia. I wonder if you could write about this and explain the different medications that would help. The medications she is on are perphenazine, Lamictal, lithium, Cogentin and insulin. She is currently on a drug called Austedo (deutetrabenazine) to try to treat the tardive dyskinesia.
R.B.
Answer: Tardive dyskinesia is a movement disorder. It is often caused by long-term use of psychiatric medicine, especially antipsychotic medicine, such as perphenazine.
Symptoms of TD often involve the face, especially uncontrolled movements of the lips and tongue, which can affect speaking and eating. Other facial and jaw muscles are affected. The abnormal movements may also include other parts of the body, including the neck and torso, but also fingers and toes.
It is much better to prevent TD than it is to treat. The condition can be largely prevented by not using antipsychotic drugs for long periods of time if possible, and using the smallest possible dose. This is especially important in people over age 50. Benztropine (Cogentin) is still sometimes used to prevent abnormal movements; however, it generally should not be used long term and stopped if TD develops. Benztropine should also not generally be used in people over 65.
If people develop TD, the first thing usually to do is to stop the medicine causing it, which appears to be the perphenazine she is taking. Unfortunately, this isn’t always possible, but it should be attempted, and perhaps replaced by a drug with lower risk of TD, such as quetiapine or clozapine.
Deutetrabenazine is a new drug with which I have no experience, but it was approved after studies showed moderate effectiveness.
I am concerned that your sister may not be receiving optimal care. Continued treatment with Cogentin and perphenazine is not the standard of care for people with tardive dyskinesia. It would be appropriate to get a second opinion. Readers may email questions to: ToYourGoodHealth@med .cornell.edu or mail questions to 628 Virginia Dr., Orlando, FL 32803.