Historical Comments on Tardive Dyskinesia: A Neurologist's Perspective

This article was undertaken to review the history of professional awareness of tardive dyskinesia (TD) and to address reasons for the delay in such recognition. The literature was reviewed, and selections are included to highlight some of the major issues. Personal recollections are deliberately emphasized since they may reflect the phenomenon of personal discovery familiar to others and the now widespread professional awareness of TD. TD is indeed well recognized by psychiatrists and neurologists, and most general practitioners are also aware that the syndrome exists. Physicians were once unfamiliar with the concept of a drug reaction that was so long delayed as is possible with TD, nor did they know that a drug side effect could present in this manner. The historical delay in initial recognition of TD, and the reason for such delay, remain of interest. The lack of a perfect therapy and the uncertainty regarding the precise pathophysiologic basis of TD remain as challenges. Most psychiatrists, and many neurologists, probably have vivid memories of specific patients with TD. This author, a neurologist, was blessed to work with George Crane and other investigators in the early days of TD and was witness to some of the original uncertainty regarding what seemed to be a new phenomenon. TD has reshaped our concepts of disease and our awareness that diseases can originate from deleterious late effects of beneficial agents.