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Tardive dyskinesia — SCE Neurology MCQ

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ModerateMovement DisordersTardive dyskinesiaSCE Neurology

A 18-year-old woman presented with orobuccal choreiform movements after long-term dopamine antagonist therapy. On examination, there was lip smacking and tongue protrusion but no rigidity. Initial investigations showed: symptoms persisted after the antipsychotic was reduced. What is the most likely underlying mechanism?

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Correct answer: C — dopamine receptor supersensitivity after chronic blockade

dopamine receptor supersensitivity after chronic blockade is the best answer because the vignette describes Tardive dyskinesia: chronic dopamine blocker exposure with choreiform mouth movements indicates tardive dyskinesia. Immune-mediated inflammatory demyelination is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. JC virus infection of oligodendrocytes and Post-infectious immune polyradiculoneuropathy are less appropriate because they would require different localisation, timing or test findings; Small-vessel lipohyalinosis would fit a different syndrome. Clinical pearl: acute dystonia occurs soon after exposure and is sustained rather than choreiform.

Reference: NICE NG71; Movement Disorder Society consensus criteria