Chulalongkorn Comprehensive Movement Disorders Center, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Postgrad Med J. 2011 Feb;87(1024):132-41. doi: 10.1136/pgmj.2010.103234. Epub 2010 Dec 3.
Tardive syndrome (TS) refers to a group of delayed onset disorders characterised by abnormal movements and caused by dopamine receptor blocking agents (DRBAs). Classical tardive dyskinesia is a specific type of oro-buccal-lingual dyskinesia. However, TS may exist in other forms--for example, stereotypy, dystonia, and akathisia--and frequently occur in combination. The onset typically is insidious and after reaching its maximum severity it often stabilises. Frequently reported risk factors are age, dose and duration of neuroleptic exposure, the use of conventional DRBAs, and co-existing mood disorders. This review highlights the broad spectrum of TS, not limited to classical tardive dyskinesia, as well as the clues for its recognition. Despite challenges in the treatment of TS, dictated by the different phenomenology, severity of TS and the need for ongoing neuroleptic treatment, the authors provide evidence based recommendations for patient management, which is not restricted to only withdrawal of the offending neuroleptics or the selection of an alternative medication, such as clozapine. In a minority of cases with significant functional disability, symptomatic or suppressive treatments should be considered. Recently, there has been a resurgence of stereotactic pallidal surgery for the treatment of TS. Although the efficacy of both pallidotomy and pallidal deep brain stimulation in dystonia has been encouraging, the evidence is still limited.
迟发性运动障碍（TDS）是一组以异常运动为特征的迟发性疾病，由多巴胺受体阻断剂（DRBAs）引起。经典迟发性运动障碍是一种特殊类型的口-颊-舌运动障碍。然而，TDS 可能以其他形式存在，例如刻板运动、肌张力障碍和静坐不能，并且经常组合出现。发病通常是隐匿的，达到最大严重程度后，病情往往会稳定下来。经常报告的风险因素包括年龄、神经阻滞剂暴露的剂量和持续时间、使用传统的 DRBAs 以及并存的情绪障碍。本综述强调了 TDS 的广泛谱，不仅限于经典迟发性运动障碍，以及识别它的线索。尽管 TDS 的治疗存在挑战，这是由不同的表型、TDS 的严重程度以及持续神经阻滞剂治疗的需要所决定的，但作者提供了基于证据的患者管理建议，不仅限于仅停用引起问题的神经阻滞剂或选择替代药物，如氯氮平。在少数有明显功能障碍的情况下，应考虑对症或抑制性治疗。最近，立体定向苍白球手术治疗 TDS 的应用又重新兴起。尽管苍白球切开术和苍白球深部脑刺激术在肌张力障碍中的疗效令人鼓舞，但证据仍然有限。
