Tardive Dyskinesia

Symptoms of Tardive Dyskinesia - Finger Movements

First identified in 1957, tardive dyskinesia was initially thought to be a condition that primarily affected the head, jaw and facial muscles. It is now known to affect all parts of the body to some degree, though not all patients will experience the same symptoms in the same parts of the body.

The symptoms of tardive dyskinesia may appear anywhere from three months to several years after a patient begins taking antipsychotic medications (or may result from withdrawal after a patient has been taken off such medication). They may be as minor as a facial twitch or can involve violent kicking. Such movements typically consist of smooth, chewing motions or sudden punching movements of the arms. They may also be repetitive, constant or intermittent.

One of the challenges involved in diagnosing and treating this disorder is that the symptoms may be due to any number of causes. In the case of tardive dyskinesia, the cause is due to an imbalance of dopamine, a chemical neurotransmitter that facilitates communication between the brain and body cells.

Antipsychotic or neuroleptic medications work by inhibiting dopamine receptors on cell surfaces. These medications are supposed to target dopamine molecules that control emotion and lower cognitive functions. However, the "first generation" of these drugs (developed between 1950 and 1970) had a tendency to affect those receptors that controlled voluntary muscle function as well — causing the uncontrolled, involuntary movement of these muscles in tardive dyskinesia patients.

Specifics of Finger Movements

Patients who are suffering from tardive dyskinesia may make fine motions with their fingers and hands. These motions may be of a "fluttering" type, as if the patient were playing an imaginary piano. Another common motion is a loose fist that contracts and relaxes. Other finger movements symptomatic of tardive dyskinesia may include finger twisting and spreading.

Because such movements may be due to a range of disorders and are often subtle, it can be difficult to determine whether or not such finger movements are actually tardive dyskinesia. Since the late 1970s, doctors have used a rating system known as the Abnormal Involuntary Movements Scale, or AIMS, to help in patient assessment.

    Sources

    1. American Psychiatric Association. Tardive Dyskinesia: A Task Force Report. (APA, 1992).
    2. Anderson, Elizabeth P. and Edward B. Freeman. "Recognition of Movement Disorders: Extrapyramidal Side Effects and Tardive Dyskinesias - Would You Recognize Them if You See Them?" Practical Gastroenterology, vol 28 no 4 (2004).
    3. Tarsy MD, Daniel. "Tardive Dyskinesia." NORD Guide to Rare Disorders (Wolters Kluwer Health, 2002).