Silva R R, Magee H J, Friedhoff A J
J Child Adolesc Psychopharmacol. 1993 Fall;3(3):137-44. doi: 10.1089/cap.1993.3.137.
ABSTRACT Two new cases are reported of persistent tardive dyskinesia associated with neuroleptic treatment of patients with Tourette's disorder. Previously, 44 cases were described in 8 published reports, including 36 children and adolescents, but diagnostic criteria were infrequently specified. In our review of these cases, using the criteria of Schooler and Kane but modified by Gualtieri's more conservative duration criteria 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 age of 8, developed fine vermicular movements of the tongue of moderate severity. Despite discontinuation of the neuroleptic, symptoms of tardive dyskinesia still persisted at age 15 and were associated with difficulty in speech production. A 42-year-old, who was treated with haloperidol 1 mg three times daily for 7 years, developed jaw movements and lip smacking that persisted for more than 2 years. Abnormal involuntary movement scale (AIMS) ratings supported a diagnosis of tardive dyskinesia in both patients with Tourette's disorder. The identification of tardive dyskinesia in the setting of a preexisting movement disorder is discussed. Features that helped distinguish the movements of tardive dyskinesia and Tourette's disorder in these patients included the premonitory 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 dyskinesia following treatment with relatively low doses of haloperidol in patients with Tourette's disorder.
摘要 本文报告了2例与使用抗精神病药物治疗抽动秽语综合征相关的持续性迟发性运动障碍新病例。此前，8篇已发表的报告中共描述了44例病例，其中包括36名儿童和青少年，但很少明确诊断标准。在我们对这些病例的回顾中，采用斯库勒和凯恩的标准，但根据瓜尔蒂耶里更保守的16周病程标准进行修改，这些病例中只有2例符合持续性迟发性运动障碍的诊断。现将这2例新病例报告如下。一名12岁儿童，自8岁起每日服用4毫克氟哌啶醇，出现了中度严重程度的舌部细微蠕动。尽管停用了抗精神病药物，但迟发性运动障碍症状在其15岁时仍持续存在，并伴有言语产生困难。一名42岁患者，每日三次服用1毫克氟哌啶醇，共7年，出现了持续两年多的下颌运动和咂唇动作。异常不自主运动量表（AIMS）评分支持这两名抽动秽语综合征患者均诊断为迟发性运动障碍。文中讨论了在已有运动障碍背景下迟发性运动障碍的识别问题。在这些患者中，有助于区分迟发性运动障碍和抽动秽语综合征运动的特征包括抽动秽语综合征症状的先兆冲动以及症状对分散注意力的自主运动任务的不同反应。临床医生在使用相对低剂量氟哌啶醇治疗抽动秽语综合征患者后，应仔细全面地寻找迟发性运动障碍的症状。
