Neuroleptic-induced tardive dystonia in young patients suffering from psychosis

Tardive dystonia is one of the extrapyramidal syndromes that start after long-term use of dopamine receptor antagonists. Tardive dystonia is underdiagnosed and often misdiagnosed; some of the treatment possibilities are hardly known among psychiatrists and are notorious for being resistant to treatment. Here, we present a set of two cases who had come with neuroleptic-induced tardive dystonia, initially given oral tetrabenazine and injectable botulinum toxin, but they did not respond. They got better after treatment with the combination of oral baclofen and electroconvulsive therapy (ECT). ECT is thought to prevent the super sensitization of postsynaptic dopamine receptors that contribute to the development of tardive states. Baclofen is a presynaptic gamma-aminobutyric acid receptor agonist primarily used to treat spasticity. Both may have acted synergistically to treat the dystonia. Tardive dystonia needs to be ruled out in patients with a history of long-term antipsychotic medication use. Consultant liaison with psychiatrists will be of paramount importance in the timely management of these cases. The combination of ECT and baclofen may be an effective choice for patients of schizophrenia with tardive dystonia developed in the course of neuroleptic treatment. However, further controlled studies are needed to develop and refine the guidelines for managing it.