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Updating the recommendations for treatment of tardive syndromes: A systematic review of new evidence and practical treatment algorithm

  • Roongroj Bhidayasiri
    Correspondence
    Corresponding author at: Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Chulalongkorn University Hospital, 1873 Rama 4 Road, Bangkok 10330, Thailand.
    Affiliations
    Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand

    Department of Neurology, Juntendo University, Tokyo, Japan
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  • Onanong Jitkritsadakul
    Affiliations
    Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
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  • Joseph H. Friedman
    Affiliations
    Butler Hospital, Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
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  • Stanley Fahn
    Affiliations
    Department of Neurology, Columbia University Medical Center, New York, USA
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Published:February 05, 2018DOI:https://doi.org/10.1016/j.jns.2018.02.010

      Highlights

      • Management of tardive syndromes is challenging, limited by a few evidence-based therapeutic options.
      • This article updates the evidence-based recommendations for TS following the AAN publication in 2013.
      • Deutetrabenazine and valbenazine are established as effective treatments of TD (Level A).
      • Pallidal DBS possibly improves TD and might be considered as a treatment (Level C).
      • Future studies are required to define the efficacy of promising agents for each TS.

      Abstract

      Background

      Management of tardive syndromes (TS) is challenging, with only a few evidence-based therapeutic algorithms reported in the American Academy of Neurology (AAN) guideline in 2013.

      Objective

      To update the evidence-based recommendations and provide a practical treatment algorithm for management of TS by addressing 5 questions: 1) Is withdrawal of dopamine receptor blocking agents (DRBAs) an effective TS treatment? 2) Does switching from typical to atypical DRBAs reduce TS symptoms? 3) What is the efficacy of pharmacologic agents in treating TS? 4) Do patients with TS benefit from chemodenervation with botulinum toxin? 5) Do patients with TS benefit from surgical therapy?

      Methods

      Systematic reviews were conducted by searching PsycINFO, Ovid MEDLINE, PubMed, EMBASE, Web of Science and Cochrane for articles published between 2012 and 2017 to identify new evidence published after the 2013 AAN guidelines. Articles were classified according to an AAN 4-tiered evidence-rating scheme. To the extent possible, for each study we attempted to categorize results based on the description of the population enrolled (tardive dyskinesia [TD], tardive dystonia, tardive tremor, etc.). Recommendations were based on the evidence.

      Results and recommendations

      New evidence was combined with the existing guideline evidence to inform our recommendations. Deutetrabenazine and valbenazine are established as effective treatments of TD (Level A) and must be recommended as treatment. Clonazepam and Ginkgo biloba probably improve TD (Level B) and should be considered as treatment. Amantadine and tetrabenazine might be considered as TD treatment (Level C). Pallidal deep brain stimulation possibly improves TD and might be considered as a treatment for intractable TD (Level C). There is insufficient evidence to support or refute TS treatment by withdrawing causative agents or switching from typical to atypical DRBA (Level U).

      Keywords

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