Tourette\'s Syndrome & Tardive Dyskinesia
The word "dyskinetic" refers to involuntary, uncontrolled physical movements, which may be congenital, due to illness or injury, or due to the use of class of medications called dopamine antagonists, which are generally used as antipsychotics (neuroleptics) for the treatment of mental illness. Less often, drugs of this type have been used in the treatment of gastrointestinal disorders, which include diabetic gastroparesis (complete or partial paralysis of the stomach) or gastroesophageal reflux disease.
Tourette's syndrome is most commonly associated with people who suddenly and for no apparent reason scream out words at any time. This is one extreme example, but this specific symptom manifests in a small minority of patients. While perhaps as many as 10 percent of the population suffer from Tourette's syndrome, the overwhelming number of cases are mild and most of these people continue to lead reasonably normal lives.
Tourettism is a set of symptoms virtually identical to true Tourette's syndrome. However, the cause is different. While the causes of Tourette's syndrome are not fully known (genetics are believed to play a part), Tourettism, like tardive dyskinesia, is a result of the side effects of dopamine-inhibiting medications.
Not all dyskinesias can be considered tourettism. What is generally considered to be "classic" tardive dyskinesia consists of involuntary movements that seem purposeful to an observer. Tardive dyskinesia is generally confined to the oro-facial muscles, and can consist of eye-rolling and rapid blinking, grimacing, chewing motions, lip smacking, pursing and puckering and worm-like tongue motions. In some cases, there is fluttering of the fingers (as if typing on a keyboard) as well as relatively slow movements of the arms, legs and feet.
Tourettism on the other hand consists mainly of tics – sudden, often spasmodic and repetitive movements that may or may not be apparent to an observer. It may include vocalizations (such as coughing, throat clearing, etc.), and the patient may experience a "premonitory urge" somewhat similar to that which occurs before sneezing or when experiencing an itch.
Causes and Treatments
Regardless of whether the condition is dyskinesia or tourettism, the causes and the treatments are similar. Dopamine is the neurotransmitter that conveys signals from the brain to various parts of the body, and plays a significant part in the regulation of the function of many bodily organs and systems. Neuroleptic medications interfere with this process by blocking the receptors that translate these signals for cells.
In some way that is not yet fully understood, blocking these signals over a period of time causes something to go wrong, resulting in a loss of control over bodily movements that are normally voluntary. The logical course of action is to either discontinue the medication that is causing the symptoms altogether and/or replace it with another drug. However, these "other" drugs (technically known as "atypical" medications) do not necessarily eliminate dyskinetic symptoms. In most cases, they simply delay the onset of such symptoms, and often have different side effects that are just as bad (or worse). In addition, sudden withdrawal of such medication may result in symptoms in and of itself.
Currently, doctors have had some success by treating tardive dyskinesia patients with "branched-chain amino acids" (BCAAs). These are a major component of muscles that support the skeleton, play a major part in the synthesis of protein, and have been used to treat burn victims. Medications that promote the function of dopamine, such as levodopa, may also be helpful.
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