Fly's tongue sign

Introduction Tardive dyskinesia (TD), also known as delayed onset dyskinesia, persistent dyskinesia, induced by antipsychotic drugs, is a persistent stereotyped repetitive involuntary movement. Children's oral and facial symptoms are more prominent, the lower muscles are most often involved, showing mouth-tongue-buster triad (BLM syndrome) or buccal, tongue, chewing syndrome, showing uncontrollable movements of the lips and tongue, such as involuntary Continuously chewing, sucking, turning tongue, tongue, mouth and drumsticks, jaw and neck, sometimes the tongue involuntarily suddenly protrudes out of the mouth, called the fly-catcher tongue, which occurs in severe cases. Unclear articulation and dysphagia.

Cause

(1) Causes of the disease

More common in long-term (more than 1 year) high doses of anti-psychotic drugs that block or bind to dopaminergic receptors, especially phenothiazines such as chlorpromazine, perphenazine, butyrylbenzenes such as haloperidol Etc., can cause TD. Certain dopamine drugs such as levodopa, Madopar, Parkinin, and tranquilizers can also cause TD-involuntary movements. Occasionally, patients who take antidepressants, anti-PD drugs, anti-epileptic drugs and antihistamines for a long time are prone to reduction or withdrawal.

Related factors include: 1 age, gender factors: old people are prone to occur, difficult to recover, more women than men; 2 brain lesions patients with antipsychotic drugs are prone to occur, negative symptoms of schizophrenia patients with early onset of TD, high incidence; 3 Drug factors: drug dose and duration of treatment are related to TD, and more common in patients with Parkinson syndrome in the early stage of treatment.

(two) pathogenesis

The pathogenesis of tardive dyskinesia is unclear, and central dopaminergic neuron damage is a doctrine. It has also been reported that the GABA energy system is functionally reduced, the neurotoxicity of free radical production, and the direct effect of antipsychotic drugs on the nervous system.

It is generally believed that long-term use of high-dose antipsychotic drugs such as phenothiazines and butyrylbenzenes can block post-synaptic dopamine receptors (DR) for a long time, and increase synaptic dopamine (DA) synthesis and release feedback. Post-synaptic DR is more sensitive to DA response, produces DR hypersensitivity, and is in a denervation hypersensitivity. Physiological doses of DA can cause dyskinesia, often induced after levodopa or discontinuation of antipsychotics. To make the symptoms worse, it also supports the refinement of TD symptoms, haloperidol can temporarily cover up the symptoms, DA synergist can make the symptoms worse.

Pathological changes: autopsy revealed degeneration and atrophy of the substantia nigra and caudate nucleus.

an examination

Related inspection

Otolaryngology CT examination of nasopharyngeal MRI

1. Occurred in older patients, especially women, with brain organic lesions mostly, with severe symptoms and slow recovery. Various antipsychotic drugs can be caused. Fluorinated anti-psychotic drugs such as fluphenazine, trifluoperazine and haloperidol are common, most of which occur after taking antipsychotic drugs for more than 1 to 2 years, and the shortest 3 to 6 Months can appear, the longest is 13 years.

The main clinical manifestations are rhythmic stereotyped repetitive involuntary movements, early manifestations of tongue tremors or salivation, the oral movement of the elderly is characteristic, and the limb involvement of young patients is common. Children's oral and facial symptoms are more prominent, the lower muscles are most often involved, showing mouth-tongue-buster triad (BLM syndrome) or buccal, tongue, chewing syndrome, showing uncontrollable movements of the lips and tongue, such as involuntary Continuously chewing, sucking, turning tongue, tongue, mouth and drumsticks, jaw and neck, sometimes the tongue involuntarily suddenly protrudes out of the mouth, called the fly-catcher tongue, which occurs in severe cases. Unclear articulation and dysphagia. The trunk muscles are affected by the body shaking, the distal part of the limb is affected by the performance of the piano finger (toe) sign, the proximal part of the limb is rarely affected, a few show dance-like movements, no purpose flapping, two legs constantly jumping, the hands and feet are moving, the trunk is twisted Sexual sports and quirky postures. Occasionally showed gastrointestinal type, stomach discomfort, nausea and vomiting occurred after sudden withdrawal. When the mood is tense and excited, the symptoms worsen and disappear when you sleep. Some patients coexist with delayed sedation, delayed dystonia, and drug-induced Parkinson syndrome. Symptoms are easily concealed and exposed when drugs are reduced or discontinued.

2. Antipsychotic drugs can cause acute idiopathic dystonia or acute sedation. It occurs within 2 days of antipsychotic drugs. It is prone to occur in children and early adulthood. It shows dramatic limbs, trunk, neck, tongue and The twitching or uncomfortable posture of the facial muscles.

3. According to the movement disorder, it is divided into the following types: 1 abnormal eye movement: performance of blinking, sputum, etc.; 2 facial muscle movement abnormalities: facial muscle twitching, convulsions and frowning face; 3 mouth muscle abnormalities: mouth, mouth , chewing, aspiration and lateral movement of the mandible; 4 abnormal movement of the tongue muscle: tongue extension, tongue reduction, peristalsis and labrum; 5 abnormal movement of the pharyngeal muscle: abnormal movement of the ankle affects pronunciation and swallowing; 6 abnormality of neck movement: Oblique neck, neck back, etc.; 7 trunk movement abnormalities: the body trunk movement is uncoordinated, in a strange posture, such as shrug shoulders, horn arches, twisting, twitching, tendon snoring and breathing difficulties, sometimes the whole body swings, Repeated flexion and extension of the trunk, front and rear twisting, called body-rocking; 8 abnormal limb movement: continuous flexion and extension of the distal end of the limb, called the piano finger (toe) sign, the proximal end is rarely affected, a few performance dance fingers Swiping action, throwing movement, moving hands and feet, moving hands, repeatedly lifting hands or jumping legs, etc.; 9 muscle tension is low - paralyzed movement disorder: involving the head, neck and waist, such as neck soft can not look up, waist soft Straight from the can and convex abdomen, leg and walking can not move enough to trail.

4. Subtype of TD: 1 Acute withdrawal syndrome: Suddenly discontinued anti-psychotic drug involuntary erratic non-repetitive dance movement, similar to small chorea or Honenting disease, more common in children, self-healing; The amount can make the dance movement gradually disappear; 2 delayed dystonia: both children and adults can occur, involuntary exercise similar to torsional dystonia or torsion spasm, persistence, does not show rapid repetitive stereotypes.

According to the patient taking antipsychotics or long-term use of antidepressants, anti-Parkinson's drugs, anti-epileptic drugs or antihistamines, dyskinesia occurs during or after 3 months of drug withdrawal, showing rhythmic stereotypes and persistent persistence Involuntary movement.

Differential diagnosis

The disease must be distinguished from the following diseases:

Drug-induced Parkinson syndrome

Because DR is occupied or blocked by antipsychotic drugs, endogenous DA can not be combined with DR, although there is also a history of antipsychotics, but involuntary exercise shows muscle rigidity, decreased movement and eye movement crisis.

2.Huntington disease

According to the genetic history, chorea and dementia and other three main signs, it is not difficult to identify with TD, HD patients are also commonly used antipsychotic drugs, if there is meditation can not be repeated or repeated stereotypes involuntary movement prompts TD.

3. Meige syndrome

Is a common oral dyskinesia, complete type of mouth, mandibular dystonia, there are eyelids; incomplete type only mouth, tongue, pharynx and mandibular dystonia, or only primary eyelid; no service Antipsychotic history.

4. Turn around

Fast, rigid and involuntary movements without taking antipsychotics.

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