Vocalizations, Breathing and Swallowing - Tardive Dyskinesia Symptoms

The most apparent manifestations of tardive dyskinesia are facial tics. Examples include vacuous chewing motions, lip smacking and movements of the tongue. This may cause audible vocalizations as well as interference with proper breathing and swallowing. In some cases, this can create a life-threatening condition.

When the symptoms of tardive dyskinesia began to surface in 1957, they were referred to as bucco-linguo-masticatory syndrome, meaning cheek-tongue-chewing. The most pronounced symptoms were noted around the mouth. The motions are often coordinated and patterned, increase with emotional arousal and can disappear completely during sleep.

Breathing Issues and Withdrawal Symptoms

A 1993 study in a Paris hospital involved 10 patients suffering from "general dyskinesias," six of which were tardive dyskinesia patients diagnosed due to the side effects of neuroleptic (psychoactive) medications. The researchers found the movement disorders affected the upper airway, interfering in a potentially fatal manner with respiration. As is the case with Parkinson's disease, tardive dyskinesia can and does result in respiratory problems that can obstruct proper breathing.

A follow-up study in 1994 by the same Paris researchers involved 12 patients. All patients were receiving neuroleptic drugs and had clear symptoms of dyskinesia of the mouth, tongue and jaw. The patients were assessed using a standard scale of measurement:

Eight suffered from speech disorders
Eight experienced respiratory difficulties
Five had regular difficulty swallowing

In addition, all but two of the subjects had "intermittent partial obstruction of the glottis due to abnormal adduction [contraction] of the vocal chords." Interestingly, these uncontrolled movements of the glottis (the combination of the vocal folds and the space between the folds) were irregular and the patients were not aware of their occurrence. The researchers concluded that laryngeal dyskinesia should be included as a side effect of antipsychotic drugs.

Dr. Peter Breggin is one psychiatrist concerned with the overuse of neuroleptic drugs, which he describes as some of the most dangerous pharmaceuticals ever developed. He has noticed that certain symptoms of laryngeal dyskinesia often manifest as withdrawal symptoms when a patient ceases taking neuroleptic medication. In some cases, these withdrawal effects are permanent and include breathing difficulties that are serious enough to require medical attention.

Dr. Breggin has also noticed "Tourette-like" symptoms that include vocalizations. He notes that while most of the symptoms involve the muscles of the neck and around the face, those fine muscles involved in speech and swallowing are often affected as well.

Sources

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).
Angelard, B et. al. "Abnormal Movements of the Larynx. Diagnostic Approach and Therapeutic Perspectives." Annales d'Oto-laryngologie et de Chirgurie Cervico Faciale, vol. 111 no. 3 (1993).
Breggin MD, Peter and David Cohen. Your Drug May Be Your Problem. (DaCapo Press, 2007)
Feve, A. et. al. "Laryngeal Tardive Dyskinesia." Journal of Neurology, vol. 242 no. 7 (July 1995).
"Habits and Disorders." http://www.tonguechewing.com/Habitdisorders.html
Stein, Jay H. Internal Medicine. (Elsevier Health Sciences, 1998).