Tardive and spontaneous dyskinesia incidence in the general population

Abstract

BackgroundTo identify the incidence rate of spontaneous dyskinesia (SD) and tardive dyskinesia (TD) in a general population and to examine the association between dykinesia and potential risk factors (exposure to metoclopramide [MCP], antipsychotic drugs, and history of diabetes and psychoses).MethodsA retrospective cohort study was conducted for the years 2001 through 2010, based on medical claims data from the Deseret Mutual Benefit Administrators (DMBA).ResultsThirty-four cases of TD and 229 cases of SD were identified. The incidence rate of TD among persons previously prescribed an antipsychotic or metoclopramide (MCP) (per 1,000) was 4.6 (1.6-7.7) for those with antipsychotic drug use only, 8.5 (4.8-12.2) for those with MCP use only, and 15.0 (2.0-28.1) for those with both antipsychotic and MCP use. In the general population, the incidence rate (per 100,000 person-years) of TD was 4.3 and of probable SD was 28.7. The incidence rates of TD and SD increased with age and were greater for females. Those with diabetes or psychoses had almost a 3-fold greater risk of TD than those without either of these diseases. Persons with schizophrenia had 31.2 times increased risk of TD than those without the disease. Positive associations also existed between the selected diseases and the incidence rate of probable SD, with persons with schizophrenia having 4.4 times greater risk of SD than those without the disease.ConclusionsSD and TD are rare in this general population. Diabetes, psychoses, and especially schizophrenia are positively associated with SD and TD. A higher proportion of those with SD present with spasm of the eyelid muscles (blepharospasm) compared more with the TD cases who present more with orofacial muscular problems.

Gastroparesis, metoclopramide, and tardive dyskinesia: Risk revisited

“…The findings of these studies, especially the Ganzini study, which is referred to for risk estimate in international guidelines, cannot be generalized because of the inherent weakness as a retrospective study of small sample size from one single clinic. Recent data from a large study in 2013 by Merrill et al support the hypothesis that the incidence of metoclopramide‐induced tardive dyskinesia is rare. The data presented are based on information from an insurance database of ~80 000 individuals over a 10‐year period, showing a low incidence rate of 4.3 cases of tardive dyskinesia per 100 000 person‐years and a prevalence of 1.8 per 1000 individuals.…”

“…These adverse reactions may be counteracted by addition of anticholinergics and are reversible after drug withdrawal. Tardive dyskinesia, characterized by involuntary disfiguring movements of the head and face, is a separate type of extrapyramidal disorder, which typically appears after long‐time use of a dopamine receptor antagonist and even after cessation of drug treatment or lowering of the dose. This movement disorder is potentially permanent.…”

“…1 In the common population, the natural incidence rate of tardive dyskinesia has been calculated to 4.3 (2.8-5.7) per 100 000 person-years, whereas with metoclopramide, data suggest a number of 8.5 (4.8-12.2) per 100 000 person-years based on data from the Deseret Mutual Benefit Administrators 2001-2010. 13 As gastroenterologists usually see young and middle age patients, tardive dyskinesia may not be commonly recognized or even visible during short consultations at an outpatient clinic. In addition, patients may not consider the complication as a drug-induced adverse effect and consultation with a neurologist for a verified diagnosis may be overlooked.…”

Valbenazine granted breakthrough drug status for treating tardive dyskinesia

“…Old age, a certain predisposition of women, mental retardation, history of substance abuse and traumatic head injury are looked as predisposing factors for the onset of tardive syndromes [8].…”

Gastroparesis

“…The risk of tardive dyskinesia is not clearly defined but is likely <1% 51 and the risk seems to be increased among those with advanced age, diabetes, and psychotic disorders. 52 Because of this risk, metoclopramide carries an FDA-issued black box warning on the package insert. Current guidelines recommend metoclopramide be used for no longer than 12 weeks, at the lowest possible dose and with close monitoring for early signs of extrapyramidal side effects.…”