Objective: To present a case of scopolamine-related Tardive Dyskinesia (TD) and review the documented anticholinergic-associated cases of TD and the underlying pathophysiology responsible for TD.

Background: TD, first reported in the 1950s as buccal-oral movements after cessation of neuroleptics, is now a widely known side effect of using neuroleptics. Several mechanisms have been proposed explaining the pathophysiology of TD, most notably dopamine receptor blockade and dopamine receptor supersensitivity. Hypocholinergic activity has also been associated with TD; most commonly with worsening neuroleptic-associated TD. Reports of anticholinergics, particularly scopolamine, inducing abnormal tardive movements in patients without prior neuroleptic use are not well documented in the literature.

Method: We reviewed electronic medical records for one patient with tardive dyskinesia seen at a tertiary movement disorders clinic and performed a literature review of previously published cases of TD and their causes.

Results: A 72-year-old man with a past medical history of asthma presented for abnormal and bothersome movements of his tongue and left leg for the past two years. Magnetic Resonance Imaging of the brain did not demonstrate a structural cause and electroencephalogram was normal without any epileptiform discharges. He denied prior use of neuroleptics, however, he endorsed a history of frequent usage of scopolamine patches for sea sickness while boating. He was later diagnosed with “tics”, but denied having these movements in childhood or any urge to perform these movements. He was then prescribed fluphenazine and deutetrabenazine for the diagnosis of tics and experienced drug-induced parkinsonism as a side effect with the onset of shuffling gait and right upper extremity rest tremor. His parkinsonism improved after weaning off these medications, but he continued to have tardive movements of his tongue and left lower extremity. He was started on valbenazine with significant improvement in his TD and minimal side effects of parkinsonism at the 60mg daily dosage.

Conclusion: Although exacerbation of TD by anticholinergics is well documented in the literature, there are few cases of anticholinergic-associated TD documented. Further investigation is essential to determine the interplay between the cholinergic and dopaminergic systems, given the frequent use of anticholinergic medications for common disorders, including nausea, COPD, urinary frequency, and asthma.

References: Cornett EM, Novitch M, Kaye AD, Kata V, Kaye AM. Medication-Induced Tardive Dyskinesia: A Review and Update. Ochsner J. 2017;17(2):162-174.

Klawans HL, Rubovits R. Effect of cholinergic and anticholinergic agents on tardive dyskinesia. J Neurol Neurosurg Psychiatry. 1974;37(8):941-947. doi:10.1136/jnnp.37.8.941.

Wolf MA, Yassa R, Llorca PM. Complications extrapyramidales induites par les neuroleptiques. Perspectives historiques [Neuroleptic-induced movement disorders: historical perspectives]. Encephale. 1993;19(6):657-661.

« Back to 2025 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/scopolamine-induced-tardive-dyskinesia-a-case-report/