Dyskinesia: Diagnosis, Therapy, Prevention

In this conclusive analysis, the chapter concerning dyskinesias will be completed; in particular, the diagnostic strategies aimed at identifying the alteration of muscle movements, the remedial therapies and, lastly, the preventive measures that can be implemented will be dealt with.

Diagnosis of dyskinesia

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

As we have extensively detailed in the previous treatments, 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 on the basis of the clinical-objective examination of the patient, associated with the "psycho-neurological analysis of the same. Furthermore, it should be remembered that dyskinesias do not always present 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 such situations the clinical picture becomes more complex, consequently both the diagnostic investigation and the therapeutic process become just as problematic.
The specialist must carefully monitor all the patient's hypokinetic or hyperkinetic movements, also evaluated through precise diagnostic criteria; among all, remember the AIMS scale (acronym of Abnormal Involuntary Movement Scal), an investigation tool useful for recognizing the initial symptoms 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 movements of the muscles is essential, 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 any anemia - and CBC - control of liver enzymes and some mineral salts) and family history to verify hypothetical neurological diseases. [adapted from guidelines for the treatment of schizophrenia by E. Sacchetti].

Treatment

In the ascertained case of tardive dyskinesia, that is due to the prolonged intake of psychotic drugs, the therapeutic strategies include a reduction of the dosage of neuroleptic substances. is completely cured of psychosis.Otherwise, when the subject complains of hypokinetic or hyperkinetic alterations in association with psychotic diseases, a gradual reduction of the pharmacological 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, we speak of withdrawal dyskinesia, which represents, however, a reversible condition.

Prevention

Given the difficulty of the therapy, preventive measures certainly represent an indispensable element: for this reason, the administration of atypical, new generation neuroleptics, therefore with fewer side effects on muscle movement, is recommended. When the patient presents initial dyskinetic signs, the doctor will have to evaluate the entity and eventually replace the neuroleptic drug with another one (in general, the replacement is carried out with substances that exert less antagonism with dopamine).
In any case, it seems that scientific research concerning alterations in muscle movements is progressing and improving: new possible effective therapeutic options have been identified, including vitamin D, botulinum toxin and tetrabenazine, capable of providing an "action" at the level of the transmission of dopaminergic signals [taken from www.discinesia.it]

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