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DEAR DR. ROACH: I'm a 66-year-old retired female who's trying to keep active. My neurologist thinks that I may have tardive dyskinesia (TD), for which I tried Ingrezza, but I experienced heaviness in my chest. I've tried meds, vestibular therapy, balance therapy and acupuncture. I've also been evaluated by an ENT physician and a cardiologist.
I've become used to the "bobbing" of my upper torso/head after the past two years. I only get relief when my head and shoulders are against something. I have been on Xanax for 15 years and may have developed this "bobbing" due to the constant use of this med. I've seen a psychiatrist, and we both agree that I'm not depressed.
I've weaned myself off all meds except for Rezdiffra for metabolic dysfunction-associated steatotic liver disease (MASH), which is being watched by my gastrointestinal doctor.
Any thoughts on where I should go from here?
-- M.B.T.
ANSWER: TD is a syndrome of uncontrollable body movements -- most commonly of the mouth and tongue -- but it can affect other muscles. Head-bobbing is possible but not common with TD.
TD from alprazolam (Xanax) or other benzodiazepines isn't reported. TD is most common after antipsychotic drugs, especially older drugs. An anti-nausea drug called metoclopramide is also well-known for causing TD, which is why it shouldn't be used for the long-term future. (The Food and Drug Administration recommends no more than 12 weeks.)
People can get transient abnormal movements when they stop alprazolam or similar drugs, but these movements tend to go away.
Head-bobbing in a 66-year-old is much more likely to be a familial tremor. A movement disorder neurologist should be consulted, as they're the experts. A family history would support the diagnosis of a familial tremor, and transient improvement with alcohol would strongly support the diagnosis.
Valbenazine (Ingrezza) is a new treatment for TD. I haven't prescribed it, and I didn't see chest heaviness as a reported side effect when I looked it up. I also didn't find TD as a risk factor for resmetirom (Rezdiffra), which is used for MASH. Given that you don't have a good risk factor for TD, and you have a single abnormal movement that isn't classical for TD, my guess is that this is a familial tremor, not TD. A movement disorder neurologist is the right consultant to confirm.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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