Dyskinesia – Causes, Symptoms & Treatment
Dyskinesia refers to involuntary, uncontrolled movements that can be caused by neurological conditions or medications. Common areas affected include the face, arms, and trunk.
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Dyskinesia refers to involuntary, uncontrolled movements that can be caused by neurological conditions or medications. Common areas affected include the face, arms, and trunk.
What is Dyskinesia?
Dyskinesia is a medical term derived from Greek, meaning abnormal or impaired movement. It describes involuntary, uncontrolled movements that the affected person cannot consciously initiate or stop. These movements may involve the face, tongue, lips, arms, legs, or trunk. Dyskinesia is not a disease in itself, but rather a symptom that can occur in the context of various neurological conditions or as a side effect of certain medications, particularly those that affect the dopamine system in the brain.
Causes
Dyskinesia can result from a wide range of underlying factors. The most common causes include:
- Drug-induced dyskinesia: One of the most frequent causes, particularly associated with medications that alter dopamine signaling in the brain. These include antipsychotics (neuroleptics) and levodopa, a cornerstone treatment for Parkinson disease.
- Parkinson disease: Dyskinesia can occur both as a feature of the disease itself and as a complication of long-term levodopa therapy.
- Tardive dyskinesia: A specific form caused by prolonged use of dopamine-blocking medications, most notably antipsychotics. It typically affects the face and mouth area.
- Huntington disease: A hereditary neurodegenerative disorder characterized by progressive, involuntary choreiform movements.
- Cerebral palsy: Brain damage occurring before, during, or shortly after birth can lead to dyskinetic movement disorders.
- Metabolic and other neurological disorders may also contribute to dyskinesia in rarer cases.
Symptoms
The symptoms of dyskinesia vary depending on the underlying cause and the body regions involved. Common manifestations include:
- Involuntary tongue movements, lip smacking, or grimacing (especially in tardive dyskinesia)
- Jerking or flinging movements of the arms and legs (chorea)
- Slow, writhing movements of the hands and fingers (athetosis)
- Sustained, twisting muscle contractions (dystonia)
- Rhythmic, trembling movements (tremor)
- Rapid, shock-like muscle jerks (myoclonus)
Symptoms can range from mild to severe and may significantly affect a person's quality of life and ability to perform daily activities.
Diagnosis
Dyskinesia is typically diagnosed by a neurologist. The diagnostic process usually involves:
- Medical history: A detailed discussion of symptoms, current medications, and underlying health conditions
- Neurological examination: Assessment of movement patterns, muscle tone, and reflexes
- Imaging studies: MRI or CT scans of the brain to rule out structural causes
- Laboratory tests: Blood tests to identify metabolic disorders
- Genetic testing: Considered when hereditary conditions such as Huntington disease are suspected
Standardized rating tools such as the AIMS (Abnormal Involuntary Movement Scale) are commonly used to assess the severity of dyskinesia.
Treatment
Treatment depends on the underlying cause and severity of the dyskinesia:
Pharmacological Treatment
- Medication adjustment: For drug-induced dyskinesia, reducing or discontinuing the causative medication is often the first step.
- Valbenazine and deutetrabenazine: FDA-approved medications specifically for tardive dyskinesia that work by reducing dopamine release.
- Tetrabenazine: Used to manage choreiform movements, particularly in Huntington disease.
- Botulinum toxin (Botox): Localized injections can be effective for focal dystonic dyskinesias.
Non-Pharmacological Treatment
- Deep brain stimulation (DBS): A neurosurgical procedure involving implanted electrodes in the brain to regulate abnormal nerve activity. Particularly effective for dyskinesia associated with Parkinson disease.
- Physical therapy and occupational therapy: Help maintain function and assist patients in managing daily activities despite movement difficulties.
- Speech therapy: Recommended when dyskinesia affects speech or swallowing.
References
- Bhidayasiri R, Fahn S, Weiner WJ et al. - Evidence-Based Guideline: Treatment of Tardive Syndromes. Neurology, 2013.
- Jankovic J, Tolosa E (Eds.) - Parkinson's Disease and Movement Disorders. 6th edition, Lippincott Williams & Wilkins, 2015.
- National Institute of Neurological Disorders and Stroke (NINDS): Dyskinesia Information Page. www.ninds.nih.gov
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