Cholinergic suppression of tardive dyskinesia

Tardive dyskinesia (TD), a hyperkinetic disorder associated with long-term neuroleptic treatment, may be a manifestation of imbalance of opposing DA and ACh dependent systems in the CNS (i.e., hyperdopamine activity or hypocholinergic function). Dopamine blocking agents give some transient relief of symptoms. Physostigmine, an anticholinesterase which enhances CNS acetylcholine action, has been given to 7 subjects with TD and measurements of their pathological movements made before, 45 min and 24 h later. All 7 subjects showed significant suppression of movement at 24 h. Many showed measurable decrement at 45 min. Side effects were minimal and transient. Physostigmine suppresses movements of TD.