[Abnormal involuntary movements in the elderly and their treatment (author's transl)].

In the elderly, there are two main types of abnormal involuntary movements: tremors on one hand and dyskinesias on the other. Among tremors, senile and parkinsonian types have to be separated because they have different semeiologic signs and distinct therapeutics. Senile tremor is present during movements and tonically maintained attitude. It affects upper extremities (often asymmetrically) and the head; it is reduced by alcohol. When possible (in the absence of contrindications) its best treatment is by beta-blockers. Parkinsonian tremor is typically present at rest and is reduced by a voluntary movement. L-dopa is active but in the elderly the dosis has to be reduced. Dyskinesias are repetitive but not rythmic involuntary movements which are made at the speed of a normal movement. There are at least two types of dyskinesias: spontaneous and post neuroleptics (i.e. tradive). Spontaneous dyskinesias essentially involve the axial muscles and are chiefly bucco-linguo-facial. They are well controlled by various neuroleptics. If eventual side effects are taken into account, tiapride appears to represent the good choice. Tardive dyskinesias do not disappear when responsible neuroleptics are stopped and are usually permanent. Paradoxically, when necessary, their treatment consists in resuming a neuroleptic prescription.