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Tardive dyskinesia (TD) is a potentially irreversible movement disorder characterized by involuntary, repetitive movements, most commonly affecting the face, tongue, and extremities. It is primarily associated with the long-term use of first-generation (typical) antipsychotics but can also occur with second-generation (atypical) antipsychotics such as aripiprazole. Despite its lower risk profile, aripiprazole can induce TD, as illustrated by a 45-year-old woman with schizophrenia who developed severe involuntary movements after five years of stable treatment with this medication. Her symptoms, including facial grimacing and choreiform movements, were assessed using the Abnormal Involuntary Movement Scale (AIMS), scoring 18, indicative of moderate to severe TD. Following a switch to clozapine and the addition of valbenazine, a VMAT2 inhibitor, the patient experienced significant symptom reduction and improved quality of life. This case emphasizes the need for ongoing monitoring of TD in patients on long-term antipsychotic therapy, even with atypical agents. Effective management strategies, including medication adjustment and the use of VMAT2 inhibitors, are crucial for optimizing patient outcomes and quality of life. Continued research is needed to better understand and address TD in clinical practice., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mulla et al.)

Tardive dyskinesia (TD) is a distressing and disabling movement disorder that occurs with the use of chronic neuroleptic medications. TD is defined as involuntary athetoid or choreiform movements of head, trunk or limbs. Tongue, lower face, jaw, and extremities are commonly involved but pharyngeal, diaphragmatic, or truncal muscles are also sometimes involved affecting breathing, swallowing, speech, posture, gait, and mobility of an individual. TD is a debilitating movement disorder that requires timely intervention. Subtle tongue movements, tic-like facial movements or increased blink frequency could be some of the initial manifestations of TD. Our article is focused on the new advents in treating TD, their efficacy, and tolerability with emphasizing their side effect profile. The implication of a genetic marker vesicular monoamine transporter 2 (VMAT2), helped in investigating VMAT2 inhibitors for alleviating TD. Among the modalities tested, only VMAT2 inhibitors reported efficacy. However, the outcome of long-term use and its side effect profile can only be determined with longer studies utilizing large set data. More clinical trials are required to explore individual drug efficacy and their long-term adverse effects. We aim to provide an overview of TD management, illustrating the priority of VMAT2 inhibitors and to determine the importance of selecting an optimal medication. A search through PubMed with terms "Tardive dyskinesia" and "VMAT2 inhibitors" was carried out. Several treatment modalities were tested to control the symptoms of TD with limited benefit. However, VMAT2 inhibitors showed improvement in the Abnormal Involuntary Movement Scale (AIMS) rating scale for TD. Valbenazine and deutetrabenazine (d-TBZ) were recently approved by the Food and Drug Administration (FDA) for treating TD in adults., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2019, Sreeram et al.)