Tiapride in the treatment of tardive dyskinesia. [Beta blockade with celiprolol in tardive dyskinesia patients treated with neuroleptics].
The effect of Tiapride on dyskinesia was evaluated in 12 patients with tardive dyskinesia in a double-blind controlled cross-over trial. The effect was measured by a Doppler-radar device and by counting the number of involuntary movements from video-recordings. Besides these methods, subjective assessments were made on analogue scales by family, nurses and attendant doctors. The subjective evaluation appeared to be useless because of many inconsistent answers. The quantitative methods revealed a significant diminution of the involuntary movements in the Tiapride therapy period (P less than 0.01). It appears that tiapride is an effective drug in the treatment of tardive dyskinesia. No clinically important side-effects have been observed. The drug appeared not to induce parkinsonism. The influence of celiprolol on the symptoms of tardive dyskinesia was compared with placebo in a randomized double blind study. 17 female patients were treated with a single daily dose of 200 mg celiprolol and 18 female patients received placebo for a period of 3 months. All patients got additional neuroleptic treatment. Celiprolol produced a small decrease in heart rate and systolic blood pressure, but had no influence on the diastolic blood pressure. The effects of celiprolol on the symptoms of tardive dyskinesia were similar to those of the placebo; in both groups improvements and deteriorations were observed. One patient of the celiprolol group became symptom free. Two cases of collapse occurred after 10 weeks of treatment with celiprolol. In one case collapse was associated with diarrhoea, in the other case the patient had preexisting hypotensive circulatory dysregulation. Sporadic reports about the effect of propranolol in patients with tardive dyskinesia might reflect the normal progress of the disease or the effect might depend on the different pharmacological profile of propranolol.
Although there has been a large amount of research in this area, most studies were excluded due to inherent problems in the nature of their crossover designs. Usually data are not reported before the crossover and the nature of TD and its likely response to treatments makes it imprudent to use this data. The review provides little usable information for service users or providers and more well designed and reported studies are indicated.