Tardive dystonia is an extrapyramidal adverse effect that can arise after prolonged use of dopamine receptor antagonists and is characterized by sustained involuntary muscle contractions frequently causing twisting and repetitive movements or abnormal postures. This occurs most commonly in the head and neck region and can begin as a focal dystonia, which then progresses to a segmental form. The prevalence of tardive dystonia in neuroleptic treated individuals ranges from 0.4% to 4%. Up to half of the patients who develop tardive dystonia tend to do so in the first 5 years of neuroleptic exposure, with onset earlier in males than females. Tardive dystonia tends to be persistent with a low remission rate of 10 percent in 6.6 years. Previous cases of tardive dystonia were mainly reported in patients with schizophrenia spectrum disorders. We report a case of tardive dystonia in a neuroleptic treated bipolar disorder and was treated with clozapine.

Tardive dystonia has been associated with both typical and atypical neuroleptic exposure, such as clozapine, olanzapine, risperidone and ziprasidone. Several authors have suggested the use of clozapine in the treatment of tardive dystonia. The ability of clozapine to treat tardive dystonia may be related to D1 receptor antagonism. There have also been case reports of tardive dystonia treated by olanzapine and quetiapine. Botulinum toxin and dopamine-depleting drugs may also be effective. More recent reports suggested the use of deep brain stimulation of regions such as globus pallidus and subthalamic nucleus in the treatment of tardive dystonia.