Tardive dystonia represents a complication of long-term use of
neuroleptics and its treatment is often unsatisfactory. Atypical
neuroleptics appear to improve
tardive dystonia, and cases of
tardive dystonia successfully managed with
clozapine have been reported. The aim of this open-label video-blinded study was to evaluate the antidystonic efficacy of
olanzapine, a new atypical
neuroleptic with a low risk of
agranulocytosis, in a group of four patients (one man and three women) with tardive
cervical dystonia. They developed severe
dystonia after several years of
neuroleptic treatment. Extensive laboratory evaluations, as well as neurophysiologic and neuroradiologic investigations, were negative.
Olanzapine was started at a dose of 5 mg/d and increased up to 7.5 mg/d. All patients were evaluated at baseline and after 2, 4, 8, and 12 weeks of treatment, using the Toronto Western
Spasmodic Torticollis Rating Scale, and videotaped. At the end of the trial, the videotapes were reviewed and scored by a blind observer. A self-rating visual analog scale completed the disability evaluation.A moderate to marked improvement in
dystonia was observed in all patients, and significant differences were observed in Toronto Western
Spasmodic Torticollis Rating Scale scores and videotape ratings after 8 and 12 weeks of treatment compared with the basal values (p < 0.05). The average percentage of improvement in Toronto Western
Spasmodic Torticollis Rating Scale score and visual analog scale was 26.4% and 42.6%, respectively. No serious side effects were reported at the maximum dosage reached (7.5 mg/d). This study warrants a larger controlled study to conclusively demonstrate the efficacy of
olanzapine in
tardive dystonia.