Brief Definition and Background of Tardive Dyskinesia and Dystonia
Tardive Dyskinesia (TD): Tardive Dyskinesia (TD) is a neurologic condition that manifests itself by involuntary repetitive movements of the tongue, face, and other body parts which cannot be controlled with deliberate intention or choice.
Antipsychotic medications that inhibit dopamine activity within the brain often cause toxic depression (TD). Unfortunately, its side effects often persist even after these antipsychotics have been discontinued.
To date, its exact mechanisms remain unclear, although experts think dopamine receptor changes and abnormal signaling in the basal ganglia may play a part. TTD can have significant ramifications on one’s quality of life, from communication difficulties and eating restrictions to the inability to participate in daily activities such as work.
Dystonia: Dystonia is a movement disorder characterized by sustained or intermittent muscle contractions that cause repetitive movements, abnormal postures, or both. These muscle contractions can lead to twisting and repetitive movements or sustained abnormal positions, varying in severity and affecting one or multiple body regions.
Dystonia can be classified as either primary or secondary. Primary dystonia has no identifiable source, while secondary dystonia usually stems from an underlying condition or medication use; its exact causes remain elusive but researchers suspect abnormalities in areas responsible for movement control in the brain such as basal ganglia. Dystonia can cause functional limitations, pain, and challenges in performing daily activities.
Both TD and Dystonia are movement disorders that can significantly impact an individual’s motor function and quality of life. While TD is often medication-induced and primarily affects the face and tongue, dystonia can have various causes and affect different body regions.
Understanding the distinct features and characteristics of TD and Dystonia is crucial for accurate diagnosis, appropriate treatment, and improved management of these conditions.
Overview of movement disorders
Movement disorders encompass a wide range of neurological conditions characterized by abnormalities in voluntary or involuntary movements. These conditions can affect various organs of the body including legs, arms and face tongue, or trunks, as well as internal organs. Movement disorders can be triggered by many causes, including medical adverse effects, brain injuries infections, and neurodegenerative illnesses.
There are several main categories of movement disorders:
Hypokinetic Disorders: These disorders involve a reduction in movement and include conditions like Parkinson’s disease, Parkinsonism, and progressive supranuclear palsy. Hypokinetic disorders may present themselves through symptoms like bradykinesia (slowness of movement) as well as tremors, rigidity, and postural stability issues.
Hyperkinetic Disorders: Hyperkinetic disorders are characterized by excessive or abnormal involuntary movements. They can be further classified into various subtypes, including:
Dystonia: Involuntary muscle contractions causing twisting movements or abnormal postures.
Chorea: Rapid, jerky, and irregular movements.
Tremor: Rhythmic oscillations of body parts, such as hands or head.
Myoclonus: Sudden, brief muscle contractions or jerks.
Tics: Repetitive, semi-voluntary movements or vocalizations.
Mixed Disorders: Some movement disorders do not fit neatly into a specific category and may exhibit a combination of hypokinetic and hyperkinetic features. Examples of mixed movement disorders include restless legs syndrome and Tourette syndrome.
Movement disorders can have profound repercussions on an individual’s daily living, quality of life, and overall well-being. Symptoms may range from mild to severe and progress over time in certain instances.
Diagnosing typically entails conducting a comprehensive medical history review, physical examination, neurological assessment, and, where relevant, imaging or genetic testing to isolate the source or rule out other conditions.
Treatment approaches for movement disorders vary depending on the specific condition and individual needs. These interventions include medications to manage symptoms, physical therapy and occupational therapy to increase mobility and functionality, surgical solutions such as deep brain stimulation (DBS), lifestyle modifications, or surgical solutions such as DBS.
Under certain conditions, an interdisciplinary team composed of neurologists, movement disorder specialists, occupational therapists; physical speech therapists; speech pathologists and psychologists may all work in concert in providing comprehensive treatment solutions.
The current research initiatives aim to uncover more knowledge about the causes and treatment options for mobility disorders, increase the quality of life for the affected, and find innovative solutions.
Increased awareness, early recognition, accurate diagnosis, and appropriate management are essential for optimizing outcomes and enhancing the lives of individuals with movement disorders.
Importance of understanding Tardive Dyskinesia (TD) and Dystonia
Understanding Tardive Dyskinesia (TD) and Dystonia is of paramount importance for several reasons:
Accurate Diagnosis: Both TD and Dystonia can present with similar movement abnormalities, making accurate diagnosis crucial. Distinguishing between these conditions is essential for appropriate treatment selection and management. Misdiagnosis can lead to ineffective or potentially harmful interventions.
Tailored Treatment: Understanding TD and Dystonia enables healthcare professionals to develop tailored treatment plans based on the specific characteristics and underlying causes of each condition. Treatment approaches for TD and Dystonia can differ significantly, and proper understanding ensures that individuals receive the most appropriate interventions.
Prevention and Management: Awareness and knowledge about TD and Dystonia allow healthcare providers to take preventive measures and manage these conditions effectively. Understanding the risk factors for TD, such as prolonged medication use, helps in monitoring individuals at risk and adjusting medication regimens to minimize the development of TD.
Patient Education and Empowerment: Educating individuals affected by TD and Dystonia about their condition helps them better understand their symptoms, treatment options, and prognosis. Knowledge empowers patients to actively participate in their care, make informed decisions, and seek appropriate support and resources.
Support and Advocacy: Understanding TD and Dystonia promotes support and advocacy for individuals living with these conditions. By bringing awareness to health professionals and the general public and policymakers, efforts could be made to increase accessibility to services, funds for research, and support networks for patients as well as their loved ones.
Research and Advancements: Understanding TD and Dystonia is essential for ongoing research and advancements in the field. By studying underlying mechanisms, risk factors, and treatment outcomes, researchers can create new interventions, enhance diagnostic criteria, and discover potential therapeutic targets.
Reduced Stigma: Knowledge about TD and Dystonia helps reduce the stigma associated with these movement disorders. Education and awareness combat misconceptions and promote understanding and empathy, fostering a more inclusive society for individuals living with these conditions.
Understanding Tardive Dyskinesia and Dystonia is crucial for accurate diagnosis, appropriate treatment, effective management, patient empowerment, research advancements, and reducing stigma. Assuring those affected by these disorders receive proper care and assistance is integral in improving outcomes and quality of life.
Tardive Dyskinesia (TD) is a neurological condition marked by involuntary and repetitive facial, tongue, or other body movements which cannot be controlled either voluntarily or deliberately.
Antipsychotic medications and any drugs which interact with dopamine function in the brain may increase risk, although other substances that alter this process could also have this impact.
“Tardive” refers to symptoms that develop over an extended period of exposure to their cause medication. No one understands exactly why Tourette Syndrome occurs; however, it is thought to result from altered dopamine receptors and an improper functioning signaling system in the basal ganglia–an area responsible for motor control within the brain.
The symptoms of TD can vary widely among individuals but commonly include facial grimacing, repetitive tongue movements, lip smacking, rapid eye blinking, and involuntary movements of the limbs or trunk.
These movements are typically purposeless and may worsen during periods of stress or anxiety. In certain instances, TD can cause functional limitations, like difficulty eating or talking, leading to a major impact on the quality of life of a person.
One of the difficulties in TD is that symptoms may persist even after the drug that causes them is stopped, which makes it a possible long-lasting disorder. In some instances, the symptoms might be relieved or disappear in time, especially in the event that the medication is discontinued before the symptoms begin to manifest or alternative treatment options are investigated.
Diagnosing TD involves assessing the individual’s symptoms, medical history, and medication use. There are specific diagnostic criteria that healthcare professionals use to determine if the symptoms are consistent with TD. It is important to distinguish TD from other movement disorders, such as dystonia, as the treatment approaches may differ.
Treatment and management of TD primarily focus on minimizing or alleviating the symptoms. This could involve changing or stopping the medication responsible for the condition, but this choice must be taken into consideration the patient’s mental illness and the possibility of the possibility of relapse.
Other pharmaceutical interventions, including medications to control dopamine function (VMAT2 inhibitors), may help manage symptoms. Non-pharmacological approaches like behavioral therapy and psychoeducation may also prove helpful for managing the impact of TD on daily life.
Understanding TD is crucial for healthcare professionals and individuals who may be at risk of developing the condition. Early detection, diagnosis, and Treatment can lessen the effects of TBI on a person’s health and improve the general quality of Life.
Causes and risk factors
The formation of Tardive Dyskinesia (TD) is predominantly a result of the usage of specific drugs specifically antipsychotics. These are often prescribed to treat mental disorders like bipolar disorder, schizophrenia along with certain mental disorders.
Other medications that impact dopamine function throughout the body, including antiemetics as well as some antidepressants may also be responsible for the formation of TD. The long-term use of these drugs can be a major risk cause for TD but the exact time and dose level for TD development is different for people.
Although medication use is the main reason for TD there are a few additional risk factors that may enhance the probability of its appearance:
Duration of Use of Medicine: The risk of developing TD is increased with time spent exposed to the causative medication. Patients taking these drugs for extended periods are at an increased risk for therapeutic discontinuation (TD), relative to those just starting or who take shorter-duration doses of them.
Dosage and potency: The higher dosages of drugs along with the utilization of stronger or more advanced antipsychotics have been associated with a higher likelihood of TD. Different drugs within the same class may be at risk of causing TD.
Individual Susceptibility: Certain people may be more predisposed genetically to develop TD. Genetic factors can affect an individual’s vulnerability to developing movement disorders, such as TD.
Gender and age: Older individuals, especially those who are over 60, are at a greater chance to develop TD. In addition, women could have a slightly greater risk than males, though the causes of this gender gap aren’t fully understood.
Co-occurring conditions: Certain medical and mental health conditions, like addiction disorders, mood disorders, and intellectual disabilities could increase the likelihood of developing TD.
Keep in mind that not everyone who uses medications known to cause TD will become affected. Certain individuals might be more at risk due to individual conditions or genetic disposition. The detection of early symptoms and signs of TD is vital to be able to intervene and modify treatments as required.
It’s recommended that health professionals take a careful look at the potential risks and benefits of using medication, especially for long-term or high-dose treatments, and to monitor regularly those at risk of TD. This proactive approach could aid in reducing the risk of TD and provide a suitable treatment in the event that it develops.
Dystonia is a movement disorder characterized by involuntary muscle contractions that result in repetitive movements, abnormal postures, or both. These muscle contractions are typically sustained and can cause twisting or repetitive motions, leading to abnormal positions of the affected body part(s).
Dystonia may affect one body part such as the neck (cervical dystonia or torticollis), hand (writer’s cramp), or face (blepharospasm); however, it can also involve multiple body regions at once (generalized dystonia).
Dystonia remains poorly understood; however, experts speculate that its cause lies within abnormalities within the basal ganglia; an area within your brain that plays an integral part in movement control.
Dystonia can be classified as primary or secondary:
Primary Dystonia: Primary dystonia refers to cases in which there is no discernable source. Gene-induced conditions are generally classified as genetic, although their specific source may differ depending on individual cases. Primary dystonia often presents in childhood or adolescence and can run in families.
Secondary Dystonia: Secondary dystonia can develop due to trauma, infection, medication use, or certain neurological disorders; its presence can occur at any age and its treatment or resolution could bring relief.
Dystonia symptoms vary considerably based on which body regions and muscles are affected, as well as which particular muscles they involve.
Common symptoms include:
Muscle contractions causing repetitive movements or abnormal postures
Twisting or turning motions of the limbs or trunk
Abnormal positioning of the head, neck, or face
Muscle cramps or pain associated with sustained contractions
Difficulty with voluntary movements and coordination
Tremors or shaking in the affected area(s)
Dystonia can have a significant impact on an individual’s daily life, causing functional limitations, pain, and challenges in performing routine tasks. Symptoms may range in intensity from mild to severe and be associated with pain and discomfort.
Diagnostic strategies for dystonia generally involve conducting an in-depth evaluation that involves reviewing medical histories and performing physical exams; when possible, imaging or genetic tests may also be utilized in making this determination. The goal is to identify any underlying causes or contributing factors and differentiate dystonia from other movement disorders.
Treatment for dystonia aims to manage symptoms, improve function, and enhance quality of life. Approaches may involve using both pharmaceutical interventions like muscle relaxants and botulinum toxin injections to decrease muscle contractions as well as physical therapy and rehabilitation techniques to manage dystonia symptoms, alongside physical therapy or deep brain stimulation (DBS), an experimental surgical process involving implanting electrodes into specific brain regions that stimulate these regions directly for those suffering severe and medication-resistant dystonia symptoms.
An accurate understanding of dystonia is vital to its accurate diagnosis, effective treatment, and successful management. A multidisciplinary approach involving neurologists, movement disorder specialists, rehabilitation specialists, and other healthcare providers must take place for proper support of individuals diagnosed with dystonia.
Causes and risk factors
Dystonia-related causes are divided into two distinct groups, primary and secondary dystonia. Each category each having its own risk elements:
a. Genetic Factors: Primary dystonia is typically thought to be a genetic condition. Certain gene mutations have been discovered in specific types of primary dystonia like DYT1 dystonia. But the genetic causes that cause many instances of primary dystonia have not yet been comprehended.
b. Family History: A primary dystonia family history increases the chance of developing the disorder. In some instances, the inheritance pattern could be autosomal dominant, which means that someone is likely to have a 50% chance that they will inherit dystonia’s gene through an affected parent.
Secondary Dystonia is a. Acquired Causes: Secondary dystonia could be caused by a variety of acquired causes, such as:
Medical Conditions: Antipsychotic and antiemetics medications (e.g. Zofran(r) and other similar products) have become popular therapies to manage symptoms associated with various medical conditions; among these drugs are antipsychotics and antiemetics (e.g. Zofran(r)). Antivert), may help medical conditions such as depression. Azithromycin, Feverfew) may help alleviate some medical symptoms; in such instances, they should only be prescribed under physician advice. metoclopramide) and some antidepressants may cause secondary dystonia.
Brain trauma: Traumatic brain injuries or surgeries, or any other incidents that cause trauma can lead to secondary dystonia.
infections: Some infections such as meningitis or encephalitis can trigger dystonia as a result of a secondary cause.
Metabolic Disorders: Certain metabolic diseases like Wilson’s Disease and mitochondrial diseases, could result in dystonia.
Stroke: The basal ganglia, or other areas that control movement can cause secondary dystonia.
b. Neurological Disorders:
Dystonia may be caused by neurological diseases that include:
Multiple system atrophy
A brain trauma that causes a brain injury. Other Factors Other potential risk causes of secondary dystonia are cerebral tumors, malformations of the vascular system, and certain neurodegenerative conditions.
It is important to remember there are risk factors that exist, but it doesn’t ensure the development of dystonia The exact reason for dystonia is different between people. In addition, certain cases of dystonia could have no known cause. These are known as Idiopathic Dystonia.
Tracing dystonia requires conducting an exhaustive assessment which includes reviewing medical history, conducting physical exams and neuroimaging scans as well as genetic testing when necessary.
Treatment for dystonia centers on reducing symptoms and enhancing the quality of life. Drugs to ease muscle contractions; botulinum toxin injections to relieve spasms; physical therapy sessions designed to increase range and function of movement physical therapy sessions for improving function and range; in certain instances surgery known as deep cerebral stimulation (DBS).
Knowing the possible risks and causes of dystonia is vital for a precise diagnosis and proper treatment. It assists health professionals to identify the best treatment options and also allows patients suffering from dystonia to receive needed assistance and treatment.
Treatment and management options
Dystonia treatment and management aim to alleviate symptoms, enhance function and enhance the overall quality of life for individuals suffering from this condition. Approaches vary according to the severity of dystonia symptoms experienced, body regions affected, and potential sources; here are some potential approaches for dystonia treatment:
Medications: Dystonia medication includes various prescriptions which may help manage symptoms effectively, including:
Muscle Relaxers: Baclofen and diazepam may provide effective muscle relaxants that can ease spasms in muscles, helping alleviate dystonic movements as well as decrease their discomfort.
Botulinum toxin injections: Botulinum toxin (Botox) can be injected into specific muscles to block nerve signals and temporarily weaken the muscle, reducing abnormal contractions and involuntary movements.
Dopamine-depleting agents: Such medicines as Tetrabenazine can reduce excessive dopamine activity, making these treatments potentially effective against specific forms of dystonia.
Physical Therapy: Physical therapy plays an essential part in managing dystonia by aiding in improving the strength of muscles and range of motion and coordination. Therapists can provide targeted exercises and stretches tailored to the individual’s specific needs.
Occupational Therapy: Occupational therapy focuses on optimizing daily living skills and adapting activities to accommodate functional limitations caused by dystonia. It may involve strategies for improving handwriting, fine motor skills, and other activities of daily living.
Speech Therapy: For individuals with dystonia affecting the vocal cords or muscles involved in speech, speech therapy can help improve speech intelligibility and teach techniques to compensate for communication difficulties.
Deep Brain Stimulation (DBS) The procedure is used in the most severe cases of dystonia, which don’t respond well to other treatments deep brain stimulation might be thought of.
It is based on implanting electrodes surgically into specific brain regions, such as the globus pallidus and subthalamic nucleus. These electrodes are connected to electrodes to an artificial pacemaker device. DBS can help modulate abnormal brain activity and reduce dystonic movements.
Psychological Support: Dealing with a chronic movement disorder like dystonia can take an emotional toll. Seeking support from mental health professionals, joining support groups, and connecting with others who have dystonia can provide valuable emotional support and coping strategies.
Assistive Devices: Depending on the specific limitations caused by dystonia, various assistive devices such as braces, splints, or adaptive equipment may be recommended to aid with daily activities and improve functional independence.
Treatment plans for dystonia should be tailored specifically to each person based on their unique requirements and characteristics. Regular follow-ups with healthcare professionals, including neurologists, movement disorder specialists, and therapists, are essential for ongoing assessment and adjustment of treatment approaches.
Dystonia is a chronic condition, so treatment should aim to manage symptoms rather than provide complete cures; the main aim is to maximize functional abilities, minimize discomfort and enhance quality-of-life for individuals living with dystonia.
Key Differences Between Tardive Dyskinesia and Dystonia
Tardive Dyskinesia (TD) and Dystonia are both movement disorders, but they have distinct characteristics and differences. Here are the primary differences between Tardive Dyskinesia and Dystonia:
Etiology and Underlying Causes:
Tardive Dyskinesia: Treatment-resistant depression (TD) usually results from exposure to long-term substances, including antipsychotics or medicines that alter dopamine’s activity in the brain. It is classified as a medication-induced movement disorder.
Dystonia: Dystonia can have multiple causes. It can be primary, with no identifiable underlying cause (genetic or idiopathic), or secondary to other conditions such as trauma, medication use, infections, or neurological disorders.
Movement Patterns and Affected Body Regions:
Tardive Dyskinesia: TD is characterized by involuntary and repetitive movements, often involving the face, tongue, and sometimes other body regions. Common TD movements include facial grimacing, lip smacking, tongue protrusion, and limb movements.
Dystonia: Dystonia is characterized by sustained or intermittent muscle contractions that cause twisting or repetitive movements and abnormal postures. Dystonia can be afflicted on a specific body part, like the neck (cervical dystonia) or the hand (writer’s cramp), or the face (blepharospasm), or may affect multiple body parts (generalized dystonia).
Relationship with Medication Use:
Tardive Dyskinesia: TD can be directly tied to certain medications, specifically antipsychotics. It typically develops as a side effect of long-term or high-dose medication use. However, TD can persist even after discontinuation of the causative medication.
Dystonia: While certain medications can cause secondary dystonia, dystonia itself is not solely dependent on medication use. It can be caused by genetic factors, underlying medical conditions, or other triggers.
Diagnostic Criteria and Assessment:
Tardive Dyskinesia: Diagnosis of TD involves evaluating the presence of characteristic involuntary movements, a history of exposure to medications known to cause TD, and the exclusion of other movement disorders. There are specific diagnostic criteria and assessment scales for TD.
Dystonia: Diagnosis of dystonia involves assessing the characteristic muscle contractions, and abnormal postures, and evaluating the underlying cause or associated factors. Diagnosing chronic fatigue syndrome requires clinical examination, medical history review, neuroimaging imaging studies and genetic testing as diagnostic tools.
Treatment Approaches and Management:
Tardive Dyskinesia: Treatment for TD often focuses on minimizing or alleviating symptoms. This may involve adjusting or discontinuing the medication that caused TD, medications that regulate dopamine function (e.g., VMAT2 inhibitors), and non-pharmacological approaches such as behavioral therapy or psychoeducation.
Dystonia Treatment: Dystonia treatment seeks to minimize symptoms, enhance function and enhance quality of life. It can include medicines (e.g. muscle relaxants, botulinum toxins injections) as well as physical therapy, occupational therapy, or, in extreme cases the procedure of deep cerebral stimulation (DBS) surgery.
Understanding these fundamental distinctions is imperative for effective diagnosis, effective treatment and efficient care for Tardive Dyskinesia as well as Dystonia. It allows healthcare professionals to tailor interventions based on the specific characteristics and underlying causes of each condition, leading to improved outcomes for individuals affected by these movement disorders.
Similarities and Overlapping Features
While Tardive Dyskinesia (TD) and Dystonia have distinct characteristics, there are also some similarities and overlapping features between the two movement disorders.
Here are some areas of similarity:
Involuntary Movements: Both TD and Dystonia involve involuntary movements of the muscles. While the specific movement patterns may differ, both disorders result in abnormal muscle contractions and repetitive movements.
Impact on Quality of Life: Both TD and Dystonia can significantly impact an individual’s quality of life. The involuntary movements and abnormal postures associated with these disorders can cause functional limitations, pain, social embarrassment, and difficulties with daily activities.
Motor Control Abnormalities: Both TD and Dystonia involve abnormalities in the control of motor movements. They disrupt the normal coordination and regulation of muscle contractions, leading to the characteristic movement abnormalities seen in these conditions.
Overlapping Symptoms: Some symptoms can be present in both TD and Dystonia, making the clinical distinction challenging in some cases. For example, both disorders can involve facial grimacing, tongue movements, and abnormal postures. This overlap can complicate the diagnosis, especially when there is a history of medication use.
Differential Diagnosis: Due to the shared clinical features, distinguishing between TD and Dystonia can be complex. At times it may be challenging to determine whether the movement disorder is predominantly driven by medication (Tardive Dyskinesia TD) or something different such as Dystonia. Predictable diagnosis requires a thorough consideration of a patient’s medical history, medication usage, and characteristics of his/her movement disorder.
Treatment Considerations: While the treatment approaches for TD and Dystonia can differ, there may be some overlap in management strategies. For example, botulinum toxin injections can be utilized in both disorders to help reduce muscle contractions and alleviate symptoms. However, the specific treatment options and approaches may vary depending on the underlying cause and individual factors.
It’s important to note that despite these similarities, TD and Dystonia remain distinct entities with different etiologies, clinical presentations, and treatment considerations. Proper diagnosis and differentiation are crucial for determining the most appropriate management strategies for each condition.
Healthcare professionals should consider the unique characteristics of each disorder when evaluating and treating individuals with movement abnormalities.
Tardive Dyskinesia vs Dystonia in Tabular Form
Sure! Here’s a tabular comparison of Tardive Dyskinesia (TD) and Dystonia:
|Tardive Dyskinesia (TD)
|Involuntary and repetitive movements
|Involuntary muscle contractions and abnormal postures
|Primary (genetic or idiopathic) or Secondary (various causes)
|Primarily affects face, tongue, and limbs
|Can affect any body region(s)
|Directly related to prolonged medication use
|Medication-induced or unrelated to medication use
|Specific criteria and assessment scales available
|Assessment involves clinical evaluation and, in some cases, imaging or genetic testing
|Medication adjustments, pharmacological interventions (e.g., VMAT2 inhibitors), non-pharmacological approaches
|Medications, botulinum toxin injections, physical therapy, occupational therapy, deep brain stimulation (in severe cases)
|Impact on Quality of Life
|Significant impact, affecting communication, eating, daily activities
|Significant impact, causing functional limitations, pain, challenges in daily tasks
|Some shared symptoms, such as facial grimacing and abnormal postures
|Overlapping symptoms can complicate diagnosis
|History of medication use and specific movement patterns
|Evaluation of underlying cause and associated factors
|Not primarily genetic, but some individual susceptibility
|Primary dystonia can have a genetic basis
Please note that this table provides a general comparison between TD and Dystonia, but individual cases may vary in their presentation and characteristics. Consultation with healthcare professionals for accurate diagnosis and tailored treatment plans is always recommended.
Tardive Dyskinesia and Dystonia are two movement disorders that can significantly impair motor functions and quality of life, often leaving survivors without enough mobility to perform daily activities easily. Though these species share similarities, each also exhibits unique qualities and distinctions that set them apart from one another.
TD is typically caused by extended use of antipsychotics and manifests itself with involuntary and repetitive facial, tongue, and limb movements that become involuntary and persistent. It is considered a medication-induced movement disorder, and its diagnosis involves evaluating the presence of characteristic movements and a history of medication use.