van Harten P N, Kahn R S
Psychiatric Center Zon & Schild, Amersfoort, The Netherlands.
Schizophr Bull. 1999;25(4):741-8. doi: 10.1093/oxfordjournals.schbul.a033415.
This paper provides an overview of the phenomenology, epidemiology, and treatment of tardive dystonia. Tardive dystonia is one of the extrapyramidal syndromes that starts after long-term use of dopamine receptor antagonists. The diagnosis is based on the presence of chronic dystonia, defined as a syndrome of sustained muscle contractions, frequently causing twisting and repetitive movements or abnormal postures. Furthermore, dystonia must develop either during or within 3 months of a course of antipsychotic treatment, and other causes such as Wilson's disease, acute dystonia, or a conversion reaction must be ruled out. Tardive dystonia occurs in about 3 percent of patients on long-term antipsychotic treatment. Some probable risk factors for tardive dystonia are younger age, male, and the presence of tardive dyskinesia. The treatment of tardive dystonia starts with an evaluation of the need for using the causative drug. If antipsychotics must be continued, a switch to an atypical antipsychotic, particularly clozapine, may be helpful. If the dystonia is relatively localized, botulinum toxin is an effective but not well-known treatment possibility. If tardive dystonia is more extensive, either dopamine-depleting drugs or high dosages of anticholinergics can be tried.
本文概述了迟发性肌张力障碍的现象学、流行病学及治疗方法。迟发性肌张力障碍是锥体外系综合征之一，在长期使用多巴胺受体拮抗剂后发病。诊断依据是存在慢性肌张力障碍，其定义为持续肌肉收缩综合征，常导致扭曲和重复性动作或异常姿势。此外，肌张力障碍必须在抗精神病药物治疗期间或治疗结束后3个月内出现，且必须排除其他病因，如威尔逊病、急性肌张力障碍或转换反应。长期接受抗精神病药物治疗的患者中，约3%会发生迟发性肌张力障碍。迟发性肌张力障碍的一些可能危险因素包括年龄较小、男性以及存在迟发性运动障碍。迟发性肌张力障碍的治疗首先要评估是否需要继续使用致病药物。如果必须继续使用抗精神病药物，换用非典型抗精神病药物，尤其是氯氮平，可能会有帮助。如果肌张力障碍相对局限，肉毒毒素是一种有效但不太为人所知的治疗选择。如果迟发性肌张力障碍范围更广，可以尝试使用耗竭多巴胺的药物或高剂量的抗胆碱能药物。
