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We gave pharmacologic doses of choline to patients with tardive dyskinesia in an attempt to suppress involuntary facial movements. Choline is the physiologic precursor of acetylcholine, and its administration elevates brain acetylcholine levels in laboratory animals and, possibly, in human beings. Hence, we thought that its use could benefit patients with diseases like tardive dyskinesia, which is believed to result from deficient central cholinergic tone. Twenty patients with stable baccal-lingual-masticatory movements took oral doses of choline for two weeks according to a double-blind crossover protocol. Plasma choline levels rose from 12.4 +/- 1.0 to 33.5 +/- 2.5 nmol per milliliter (mean +/- S.E.M.; P less than 0.001) during this period. Choreic movements decreased in nine patients, worsened in one and were unchanged in 10. Thus, oral doses of choline can be useful in neurologic diseases in which an increase in acetylcholine release is desired.