Tardive dyskinesia is an extrapyramidal syndrome associated with the
chronic administration of major neuroleptic agents. The pathogenesis of the
disorder appears to relate to chronic striatal dopaminergic receptor site
blockade; the pathophysiology of tardive dyskinesia appears to relate to
the resultant denervation hypersensitivity. Agents that deplete the brain
of dopamine are the mainstay of therapy for tardive dyskinesia. Cholinergic
agents that potentially modulate the balance between dopamine and
acetycholine in the striatum offer possible additional therapeutic options.
Clearly, resumption of neuroleptic therapy is treatment with the presumed
pathogenic agent and is to be avoided whenever possible.