Dyskinesia: Diagnosis, Therapy, Prevention

In this conclusive analysis, the chapter on dyskinesias will be completed; in particular, the diagnostic strategies aimed at identifying the alteration of the muscular movements, the resolutive therapies and, finally, the feasible preventive measures will be treated.

Diagnosis of dyskinesia

Dyskinesias are sometimes extremely complex clinical profiles, such as to require a multidisciplinary approach.

As we have amply investigated in previous treatises, there are many forms of dyskinesias and it is precisely for this reason that the diagnosis must be careful and precise. In general, the diagnostic investigation is evaluated based on the patient's clinical-objective examination, associated with the psycho-neurological analysis of the same. Furthermore, it should be remembered that dyskinesias do not always occur with the same clinical manifestations since, over time, the disease could degenerate and involve other muscle groups, thus causing further dyskinesias: it is evident that in similar situations the clinical picture becomes more complex, consequently both the diagnostic investigation and the therapeutic process become equally problematic.

The specialist must carefully check all hypokinetic or hyperkinetic movements of the patient, also evaluated through precise diagnostic criteria; of all, we recall the AIMS scale (acronym of Abnormal Involuntary Movement Scal), a survey tool useful for recognizing the initial symptomatology of dyskinesia and for monitoring any pathological degeneration over time. [taken from www.discinesia.it]

In particular, for those patients forced to take antipsychotic drugs for periods longer than one month, the control of involuntary muscle movements is fundamental, in order to identify the initial secondary effects and their possible negative evolution.

In some cases, the diagnosis also includes laboratory tests (eg SMA-18 - detection of possible anemia - and CBC - control of liver enzymes and some mineral salts) and family history to verify hypothetical diseases of neurological origin. [taken from guidelines for the treatment of schizophrenia by E. Sacchetti].

Care

In the ascertained case of tardive dyskinesia, that is due to the prolonged intake of psychotic drugs, therapeutic strategies include a reduction in the posology of neuroleptic substances. The suspension of the drug represents a possible solution, certainly decisive for the patient, but only appropriate when the patient has completely recovered from psychosis. Otherwise, when the subject complains of hypokinetic or hyperkinetic alterations in association with psychotic diseases, gradual reduction of the drug dose is recommended, but never total suspension.

In some cases, the interruption of drug therapy generates an initial and paradoxical strengthening of dyskinesias: in similar situations, one speaks of abstinence dyskinesia, which represents, however, a reversible condition.

Prevention

Given the difficulty of the therapy, preventive measures certainly represent an indispensable element: for this reason, it is recommended to administer atypical neuroleptics, a new generation, therefore with fewer side effects on muscle movement. When the patient presents initial dyskinetic signals, the doctor will have to evaluate the entity and eventually replace the neuroleptic drug with another (in general, the substitution is carried out with substances that exert less antagonism with dopamine).

However, it seems that scientific research concerning the alterations of muscle movements progresses and improves: new possible effective therapeutic options have been identified, including vitamin D, botulinum toxin and tetrabenazine, able to give an action at the level of transmission of dopaminergic signals [taken from www.discinesia.it]

As we have analyzed, dyskinesias can have unpredictable results, for this reason it is necessary to first trace a precise diagnostic profile, to then intervene promptly with appropriate therapies, in compliance with the prophylactic methods of the dyskinetic disease.