Tardive akathisia: A state of mental agitation that causes an inner sense of restlessness with an inability to sit still, typically in the trunk or legs. It presents as body rocking movements, shifting weight from one foot to another, marching in place, and/or continual crossing and uncrossing of the legs. Sometimes it is associated with moaning or repetitive touching movements. It is one of the most disabling and difficult to treat tardive syndromes. (Founder’s comment: Akathisia can also cause a debilitating inner terror and a feeling as if the person is on fire or their blood is boiling, with or without visible outer symptoms. Visit the Akathisia Alliance for Education and Research for more information.)

Tardive chorea: Random, jerking movements that flow from one body region to the next, in an unpredictable manner.

Tardive dystonia: Usually presents as eye twitching, oral and jaw muscle contractions, repetitive muscle contractions that cause neck extension, trunk hyperextension, arm hyperextension and wrist flexion. It can sometimes be severe enough to cause life-threatening swallowing difficulties.

Tardive gait: Tripping and shuffling movements of the feet with difficulty standing and moving from one place to the other.

Tardive ocular deviations: Spasmodic movements of the eyes with deviation in the upward direction that last for several seconds or minutes.

Tardive myoclonus: Often presents as a brief, jerk-like muscle contraction in the upper extremities, usually in the arms and shoulders.

Tardive sensory syndrome (tardive pain): A chronic burning sensation usually limited to the mouth and/or genitalia.

Tardive parkinsonism: Parkinsonism that persists after discontinuation from dopamine receptor blocking agents (DRBAs), with a normal SPECT scan. Other than the history of DRBAs use and the presence of other tardive syndromes, there are no other features that separate it from other causes of parkinsonism. Considered very rare.

Tardive tics (tardive Tourette’s): Sudden, brief, sporadic involuntary movements or sounds.

Tardive tremor: A tremor that occurs while at complete rest or with voluntary action. It may affect any part of the body, but most often affects the arms and hands.

Copulatory dyskinesia: Thrusting movements of the trunk and pelvis.

Esophageal dyskinesia: It can lead to asphyxiation of food and is potentially life-threatening.

Rabbit syndrome: Fine, rhythmic actions at rest, that mimic the chewing actions of a rabbit. The tongue is usually not involved.

Respiratory dyskinesia: The respiratory pattern is affected. It causes irregular inhalation and exhalation during breathing. This leads to hyperventilation and hypoventilation, at different times. It can also lead to aspiration pneumonia.

Stereotypy: Seeming purposeful, repetitive (rather than random) and coordinated movements that can appear like rituals. Though they seem purposeful, they are involuntary. Examples include the “piano-playing fingers” and “hand clasping” sometimes seen in TD.

Withdrawal emergent syndrome: Occurs in patients rapidly withdrawn from DRBAs. The movements usually mainly involve the neck, trunk and limbs. The oral-buccal-lingual muscles are rarely involved. It is usually time-limited to four to eight weeks, but when it persists more than eight weeks it is considered tardive dyskinesia. The slow tapering of DRBAs reduces the risk of this syndrome.

Fahn, S., Jankovic, J., & Hallett, M. (2011). The tardive syndromes. In Principles and Practice of Movement Disorders (2nd ed., pp. 415–446). Elsevier Saunders.

Frei, K. D., Truong, D. A., Fahn, S., Jankovic, J., & Hauser, R. A. (2018). The Nosology of Tardive Syndromes. Journal of the Neurological Sciences, 389(1), 10–16.

Savitt, D. & Jankovic, J. (2018) Tardive Syndromes. Journal of the Neurological Sciences, 389(1), 35-42.