Tardive syndrome (TS) refers to a group of delayed onset disorders characterised by
abnormal movements and caused by
dopamine receptor blocking agents (DRBAs). Classical
tardive dyskinesia is a specific type of oro-buccal-lingual
dyskinesia. However, TS may exist in other forms--for example, stereotypy,
dystonia, and
akathisia--and frequently occur in combination. The onset typically is insidious and after reaching its maximum severity it often stabilises. Frequently reported risk factors are age, dose and duration of
neuroleptic exposure, the use of conventional DRBAs, and co-existing
mood disorders. This review highlights the broad spectrum of TS, not limited to classical
tardive dyskinesia, as well as the clues for its recognition. Despite challenges in the treatment of TS, dictated by the different phenomenology, severity of TS and the need for ongoing
neuroleptic treatment, the authors provide evidence based recommendations for patient management, which is not restricted to only withdrawal of the offending
neuroleptics or the selection of an alternative medication, such as
clozapine. In a minority of cases with significant functional disability, symptomatic or suppressive treatments should be considered. Recently, there has been a resurgence of stereotactic pallidal surgery for the treatment of TS. Although the efficacy of both
pallidotomy and pallidal
deep brain stimulation in
dystonia has been encouraging, the evidence is still limited.