PERSISTENT TARDIVE-DYSKINESIA AND OTHER NEUROLEPTIC-RELATED DYSKINESIAS IN TOURETTES DISORDER

Two new cases are reported of persistent tardive dyskinesia associated with neuroleptic treatment of patients with Tourette's disorder. Prev iously, 44 cases were described in 8 published reports, including 36 c hildren and adolescents, but diagnostic criteria were infrequently spe cified. In our review of these cases, using the criteria of Schooler a nd Kane but modified by Gualtieri's more conservative duration criteri a of 16 weeks, only 2 of these cases were consistent with a diagnosis of persistent tardive dyskinesia. The 2 new cases are reported here. A 12-year-old, who was treated with haloperidol 4 mg daily since the ag e of 8, developed fine vermicular movements of the tongue of moderate severity. Despite discontinuation of the neuroleptic, symptoms of tard ive dyskinesia still persisted at age 15 and were associated with diff iculty in speech production. A 42-year-old, who was treated with halop eridol 1 mg three times daily for 7 years, developed jaw movements and lip smacking that persisted for more than 2 years. Abnormal involunta ry movement scale (AIMS) ratings supported a diagnosis of tardive dysk inesia in both patients with Tourette's disorder. The identification o f tardive dyskinesia in the setting of a preexisting movement disorder is discussed. Features that helped distinguish the movements of tardi ve dyskinesia and Tourette's disorder in these patients included the p remonitory urges of Tourette's symptoms and a differential response of the symptoms to distracting voluntary motor tasks. Clinicians should be attentive and thorough in searching for symptoms of tardive dyskine sia following treatment with relatively low doses of haloperidol in pa tients with Tourette's disorder.