Neuromodulation therapies in the management of tardive dyskinesia: A scoping review.

Abstract

Background: Tardive dyskinesia (TD) comprises persistent involuntary movements that usually emerge after sustained treatment with dopamine receptor blocking agents.

Objectives: Although vesicular monoamine transporter 2 (VMAT2) inhibitors have expanded treatment options, a proportion of patients continue to experience disabling symptoms, prompting interest in neuromodulator interventions.

Methods: Evidence was retrieved from three databases, PubMed, Scopus, and Web of Science, with coverage limited to English-language publications dated January 2000-September 2025. Studies reporting the use of deep brain stimulation (DBS), electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), or transcranial direct current stimulation (tDCS) for TD were charted, and the extracted findings were grouped according to neuromodulation modality following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidance.

Results: Included studies comprised DBS, ECT, rTMS, and tDCS reports, with evidence ranging from randomized controlled trials to case reports. Globus pallidus internus deep brain stimulation (GPi-DBS) showed the most consistent and durable benefit, with prospective studies reporting approximately 56%-63% improvement on extrapyramidal symptom rating scale (ESRS) and abnormal involuntary movement scale (AIMS) outcomes. ECT was associated with AIMS improvement in one small retrospective study and three case-reports. rTMS showed preliminary benefit, although protocols were heterogeneous and TD-specific controlled outcomes were limited. tDCS showed emerging benefit, particularly for facial-oral dyskinesia.

Conclusion: Neuromodulation is a promising adjunctive option for refractory TD. GPi-DBS has the strongest evidence, whereas rTMS and tDCS remain investigational and require larger controlled trials.