Spätdyskinesien – Geschichte, Definition, Differenzialdiagnose und Therapie

Zusammenfassung

Seit Einführung einer Behandlung mit Neuroleptika vor etwa 50 Jahren sind hiermit assoziierte tardive Syndrome bekannt. Diese, insbesondere typische oro-bukko-linguo-mastikatorische Dyskinesien, tardive Dystonie, tardiver Tourettismus, tardiver Myoklonus oder tardiver Tremor, treten zwar unter einer Behandlung mit den zunehmend eingesetzten sog. atypischen Neuroleptika, seltener auf als bei klassischen Neuroleptika, stellen aber weiterhin im klinischen Alltag ein bedeutsames diagnostisches und therapeutisches Problem dar. Risikofaktoren sind höheres Lebensalter, weibliches Geschlecht, psychiatrische Ko-Morbiditäten und strukturelle Hirnläsionen. Bei der psychiatrischen Behandlung sind – aus neurologischer Sicht – der Einsatz von Clozapin, Olanzapin und Quetiapin zu empfehlen, bei denen das Risiko des Auftretens tardiver Syndrome bei < 3% liegt. Treten diese unter einer neuroleptischen Behandlung auf, sollte zunächst ein Ausschleichen des auslösenden Medikaments versucht werden, bzw. der Ersatz durch ein atypisches Neuroleptikum in möglichst niedrigen Dosisbereichen. Symptomatisch kann eine Behandlung mit Tetrabenazin oder, bei fokaler und segmentaler Dystonie, lokalen Botulinumtoxin Injektionen, hilfreich sein. Bei Therapie-refraktären Patienten ist die Tiefe Hirnstimulation des Globus pallidus internus zu erwägen, zu der ermutigende Studienergebnisse vorliegen.

Abstract

More than half a century has passed since the introduction of the first neuroleptic treatment and initial reports of associated tardive syndromes. Despite the increasing use of second generation (atypical) neuroleptic drugs, tardive syndromes – encompassing the classical oro-bucco-linguo-masticatory dyskinesias, tardive dystonia, tardive Tourretism, tardive myoclonus and tardive tremor – still pose a diagnostic and therapeutic challenge for treating specialists. Risk factors for their development are older age and female gender as well as the presence of psychiatric co-morbidities and structural brain lesions. To prevent tardive syndromes atypical neuroleptics should be preferred over typicals, with clozapine, olanzapine and quetiapine showing a risk for their development of less than 3%. Treatment strategies for tardive syndromes include tapering the offending drug, introduction of atypical neuroleptics at low doses and the usage of tetrabenazine. Botulinum toxin injections are a good option for focal and segmental dystonia. Deep brain stimulation can be an effective alternative in the treatment of refractory patients with encouraging long-term results.

Schlüsselwörter

tardive Syndrome - Spätdyskinesien - Neuroleptika

Keywords

tardive syndromes - late dyskinesias - neuroleptic agents

• Literatur

• 1 Deniker P. From chlorpromazine to tardive dyskinesia (brief history of the neuroleptics). Psychiatr J Univ Ott 1989; 14: 253-259
• 2 Healy D. The creation of psychopharmacology. Cambridge, MA. Harvard University Press; 2002
• 3 Schonecker M. Beitrag zu der Mitteilung von Kulenkampff und Tarnow. Ein eigentumliches Syndrom im oralen Bereich bei Megaphenapplikation. Nervenarzt 1957; 28: 35
• 4 Sigwald J, Bouttier D, Raymondeaud C et al. Quatre cas de dyskinesie facio-bucco-linguo-masticatrice a Tevolution prolongee secondaire a un traitement par les neuroleptiques. Rev Neurol (Paris) 1959; 100: 751-755
• 5 Kruse W. Persistent muscular restlessness after phenothiazine treatment: report of 3 cases. Am J Psychiatry 1960; 117: 152-153
• 6 Uhrbrand L, Faurbye A. Reversible and irreversible dyskinesia after treatment with perphenazine, chlorpromazine, reserpine and electroconvulsive therapy. Psychopharmacologia 1960; 1: 408-418
• 7 Hunter R, Earl CJ, Janz D. A Syndrome of Abnormal Movements and Dementia in Leucotomized Patients Treated with Phenothiazines. J Neurol Neurosurg Psychiatry 1964; 27: 219-223
• 8 Hunter R, Earl CJ, Thronicroft S. An Apparently Irreversible Syndrome of Abnormal Movements Following Phenothiazine Medication. Proc R Soc Med 1964; 57: 758-762
• 9 Ayd Jr FJ. A survey of drug-induced extrapyramidal reactions. JAMA 1961; 175: 1054-1060
• 10 Degkwitz R, Wenzel W, Binsack KF et al. On the problem of the terminal extrapyramidal hyperkineses as observed in 1 600 patients during long-term therapy with neuroleptics. Arzneimittelforschung 1966; 16: 276-279
• 11 Degkwitz R, Binsack KF, Herkert H et al. On the problem of persistent extrapyramidal hyperkinesia following prolonged use of neuroleptics. Nervenarzt 1967; 38: 170-174
• 12 Yassa R, Jeste DV. Tardive dyskinesia 1988: 31 years later. J Clin Psychopharmacol 1988; 8: 1S
• 13 Factor SA, Lang AE et al. Drug induced movement disorders. Malden, Mass: Blackwell Futura; 2005
• 14 Bhidayasiri R, Boonyawairoj S. Spectrum of tardive syndromes: clinical recognition and management. Postgrad Med J 2011; 87: 132-141
• 15 Schooler NR, Kane JM. Research diagnoses for tardive dyskinesia. Arch Gen Psychiatry 1982; 39: 486-487
• 16 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders DSM IV-TR (4^th edition, Text Revision). Washington, DC: American Psychiatric Association; 2000
• 17 Skidmore F, Weiner WJ, Burke R. Neuroleptic-induced tardive dyskinesia variants. In: Factor SA, Lang E. et al. Drug induced movement disorders. Malden, Mass: Blackwell Futura; 2005
• 18 Burke RE, Fahn S, Jankovic J et al. Tardive dystonia: late-onset and persistent dystonia caused by antipsychotic drugs. Neurology 1982; 32: 1335-1346
• 19 Fahn S. The Tardive Syndromes: Phenomenology, Concepts on Pathophysiology & Treatment. A Comprehensive Review of Movement Disorders for the Clinical Practioner 2003; 181-265
• 20 Tominaga H, Fukuzako H, Izumi K et al. Tardive myoclonus. Lancet 1987; 1: 322
• 21 Klawans HL, Falk DK, Nausieda PA et al. Gilles de la Tourette syndrome after long-term chlorpromazine therapy. Neurology 1978; 28: 1064-1066
• 22 Stacy M, Jankovic J. Tardive tremor. Mov Disord 1992; 7: 53-57
• 23 Kane JM, Smith JM. Tardive dyskinesia: prevalence and risk factors, 1959 to 1979. Arch Gen Psychiatry 1982; 39: 473-481
• 24 Novick D, Haro JM, Perrin E et al. Tolerability of outpatient antipsychotic treatment: 36-month results from the European Schizophrenia Outpatient Health Outcomes (SOHO) study. Eur Neuropsychopharmacol 2009; 19: 542-550
• 25 McDonagh M, Peterson K, Carson S et al. Drug Class Review. Atypical antipsychotic drugs Final Update 3 Report. Portland (OR) Oregon Health & Science University 2010;
• 26 Pena MS, Yaltho TC, Jankovic J. Tardive dyskinesia and other movement disorders secondary to aripiprazole. Mov Disord 2011; 26: 147-152
• 27 Kiriakakis V, Bhatia KP, Quinn NP et al. The natural history of tardive dystonia. A long-term follow-up study of 107 cases. Brain 1998; 121: 2053-2066
• 28 Yassa R, Nair NPV et al. Neuroleptic-induced movement disorders. Cambridge; New York: Cambridge University Press; 1997
• 29 APA. Task Force on Tardive Dyskinesia: Tardive Dyskinesia – A Task Force Report of the American Psychiatric Association. Washington, DC: APA Press; 1992
• 30 Jeste DV, Wyatt RJ. In search of treatment for tardive dyskinesia: review of the literature. Schizophr Bull 1979; 5: 251-293
• 31 Glazer WM, Bowers Jr MB, Charney DS et al. The effect of neuroleptic discontinuation on psychopathology, involuntary movements, and biochemical measures in patients with persistent tardive dyskinesia. Biol Psychiatry 1989; 26: 224-233
• 32 Klawans HL, Tanner CM, Barr A. The reversibility of „permanent“ tardive dyskinesia. Clin Neuropharmacol 1984; 7: 153-159
• 33 Gardos G, Cole JO, Rapkin RM et al. Anticholinergic challenge and neuroleptic withdrawal. Changes in dyskinesia and symptom measures. Arch Gen Psychiatry 1984; 41: 1030-1035
• 34 Dixon L, Thaker G, Conley R et al. Changes in psychopathology and dyskinesia after neuroleptic withdrawal in a double-blind design. Schizophr Res 1993; 10: 267-271
• 35 Kang UJ, Burke RE, Fahn S. Natural history and treatment of tardive dystonia. Mov Disord 1986; 1: 193-208
• 36 Fahn S. High dosage anticholinergic therapy in dystonia. Neurology 1983; 33: 1255-1261
• 37 Munchau A, Bhatia KP. Uses of botulinum toxin injection in medicine today. BMJ 2000; 320: 161-165
• 38 Kazamatsuri H, Chien C, Cole JO. Treatment of tardive dyskinesia. I. Clinical efficacy of a dopamine-depleting agent, tetrabenazine. Arch Gen Psychiatry 1972; 27: 95-99
• 39 Kazamatsuri H, Chien CP, Cole JO. Long-term treatment of tardive dyskinesia with haloperidol and tetrabenazine. Am J Psychiatry 1973; 130: 479-483
• 40 Ondo WG, Hanna PA, Jankovic J. Tetrabenazine treatment for tardive dyskinesia; assessment by randomized videotape protocol. Am J Psychiatry 1999; 156: 1279-1281
• 41 Leung GJ, Breden EL. Tetrabenazine for the treatment of tardive dyskinesia. Ann Pharmacother 2011; 45: 525-531
• 42 Guay DR. Tetrabenazine, a monoamine-depleting drug used in the treatment of hyperkinetic movement disorders. Am J Geriatr Pharmacother 2010; 8: 331-373
• 43 Gruber D, Trottenberg T, Kivi A et al. Long-term effects of pallidal deep brain stimulation in tardive dystonia. Neurology 2009; 73: 53-58
• 44 Chang EF, Schrock LE, Starr PA et al. Long-term benefit sustained after bilateral pallidal deep brain stimulation in patients with refractory tardive dystonia. Stereotact Funct Neurosurg 2010; 88: 304-310
• 45 Speelman JD, Contarino MF, Schuurman PR et al. Deep brain stimula­tion for dystonia: patient selection and outcomes. Eur J Neurol 2010; 17 (Suppl. 01) 102-106
• 46 Capelle HH, Blahak C, Schrader C et al. Chronic deep brain stimulation in patients with tardive dystonia without a history of major psychosis. Mov Disord 2010; 25: 1477-1481
• 47 Andrews C, Aviles-Olmos I, Hariz M et al. Which patients with dystonia benefit from deep brain stimulation? A metaregression of individual patient outcomes. J Neurol Neurosurg Psychiatry 2010; 81: 1383-1389