Bilateral posteroventral pallidotomy for severe antipsychotic induced tardive dyskinesia and dystonia

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 63; no. 4; pp. 554 - 556
• Main Authors: WEETMAN, J, ANDERSON, I M, GREGORY, R P, GILL, S S
• Format: Journal Article
• Language: English
• Published: London BMJ 01.10.1997; BMJ Publishing Group LTD; BMJ Group
• Subjects: Adult; Antipsychotic Agents - adverse effects; Biological and medical sciences; Diseases of the nervous system; Dyskinesia, Drug-Induced - etiology; Globus Pallidus - pathology; Globus Pallidus - surgery; Hallucinations; Humans; Illnesses; Letters to the Editor; Magnetic Resonance Imaging; Male; Medical sciences; Parkinson's disease; Prescription drugs; Psychotropic drugs; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Severity of Illness Index; Time Factors; Human; Nervous system diseases; Late; Neuroleptic; Psychotropic; Instrumentation therapy; Bilateral; Male; Stereotaxia; Pallidum; Involuntary movement; Thermocoagulation; Case study; Refractory; Striated muscle disease; Chemotherapy; Young adult; Antipsychotic; Complication; Dystonia; Flupentixol; Neurological disorder; Extrapyramidal syndrome; Dyskinesia
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.63.4.554a

Stimulation studies confirmed avoidance of the internal capsule and optic tract. Because of the severity of the involuntary movements it was not possible to use high frequency stimulation to mimic the lesion. The picture was consistent with suggested characteristic features of patients with tardive dystonia; male sex, early age of onset after a fairly short duration of antipsychotic treatment, and a high degree of disability. 6 There is no recognised specific treatment for tardive movement disorders but the patient described here had received aggressive drug treatment involving strategies described as helpful in case reports including the combination of clozapine and clonazepam recently reported to be helpful in severe cases of tardive dystonia. 7 Posteroventral pallidotomy is effective in treating both the akinetic and hyperkinetic motor symptoms in Parkinson's disease. 5 A recent case report described successful use in tardive dyskinesia 8 but it has not to our knowledge been reported in drug induced tardive dystonia.