Branched-Chain Amino Acids Helpful in Tardive Dyskinesia

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This " disease " is due to the toxic effects of certain pharmacuetical drugs. The

treatment is a natural nutrient needed for repair.

 

F.

 

http://www.medscape.com/viewarticle/457219

 

Branched-Chain Amino Acids Helpful in Tardive Dyskinesia

 

 

June 13, 2003 — Branched-chain amino acids offer a robust and rapid treatment

response for tardive dyskinesia in men, according to the results of a randomized

trial published in the June issue of the American Journal of Psychiatry.

 

" Since the aromatic amino acids are precursors of the amine neurotransmitters,

ingestion of branched-chain amino acids can decrease the central synthesis of

the neurotransmitters dopamine, noradrenaline, and serotonin, " write Mary Ann

Richardson, PhD, and colleagues from the Nathan S. Kline Institute for

Psychiatric Research in Orangeburg, New York. " To our knowledge, the present

study is the first placebo-controlled trial of branched-chain amino acids for

the treatment of tardive dyskinesia. "

 

Thirty-six men with long histories of antipsychotic treatment and tardive

dyskinesia were randomized to receive branched-chain amino acids, 222 mg/kg, or

placebo, three times daily for three weeks.

 

There was a robust and highly significant difference between groups in frequency

count of videotaped tardive dyskinesia movements, which was not related to

changes in antipsychotic and glucose plasma levels. However, significant

positive correlations between decreases in tardive dyskinesia symptoms and

decreases in aromatic amino acid plasma concentrations during the trial

suggested that treatment response was related to decreased amine

neurotransmitter synthesis.

 

Minimal gastrointestinal symptoms were seen during the trial, and no clinically

significant differences between the pre- and posttrial results of physical

examinations and laboratory screening tests.

 

" Branched-chain amino acids constitute a novel, safe treatment for tardive

dyskinesia, with a strong potential for providing significant improvement in the

diseased physiognomy of the afflicted person, " the authors write. " It is

unfortunate, given that diabetes has been shown to be a risk factor for tardive

dyskinesia, that this disorder needs to be considered a contraindication for use

of the current branched-chain amino acids formulation. "

 

This study was received a grant from the National Institute of Mental Health,

institutional support from the New York State Office of Mental Health, and a

grant and product support from Scientific Hospital Supplies International, Ltd.

 

Am J Psychiatry. 2003;160:1117-1124

Learning ObjectivesUpon completion of this activity, participants will be able

to:

List the characteristics of tardive dyskinesia.

Describe the results of a randomized trial of a branched-chain amino acid

formulation in the treatment of men with tardive dyskinesia.

Clinical Context

According to Harrison's Principles of Internal Medicine, tardive dyskinesia is a

" severe side-effect of long-term use of the classic antipsychotic agents. " It

occurs in about 25% to 50% of all patients who take these drugs for longer than

six months. The risk increases with advancing age, but its pathogenesis is

unclear.

 

The clinical features of tardive dyskinesia include abnormal choreoathetoid

movements, especially involving the face and mouth in adults and the limbs in

children. Tardive dyskinesia may be focal, producing, for example,

blepharospasm, torticollis, or oromandibular dystonia, or it may affect

contiguous body parts (eg, the face and neck or arm and trunk). Generalized

dystonia is uncommon, especially in older patients.

 

The dietary approach to treating tardive dyskinesia stems from several

observations. The first was that phenylketonuria was a risk factor for tardive

dyskinesia. Further study, as reported by Richardson and colleagues during the

1996 American Psychiatric Association annual meeting, revealed that patients

with tardive dyskinesia had impaired kinetics of phenylalanine. Another

observation was the complete resolution of tardive dyskinesia in about half of

patients provided with a protein meal. The protein in this meal was found to

have 19.6% branched-chain amino acids (isoleucine, leucine, and valine) and 7.5%

aromatic amino acids (phenylalanine, tyrosine, and tryptophan). This led to the

development of a food product with a similar proportion of branched chain to

aromatic amino acids, which, in a trial reported by Richardson and colleagues in

the April 1999 issue of Psychopharmacology, resulted in a significant decrease

in tardive dyskinesia symptoms.

 

Dr. Richardson and colleagues write, " Since the aromatic amino acids are

precursors of the amine neurotransmitters, ingestion of branched-chain amino

acids can decrease the central synthesis of the neurotransmitters dopamine,

noradrenaline, and serotonin. This treatment mechanism has been used

successfully in disorders such as hepatic encephalopathy, in which a decrease in

the central synthesis of these neurotransmitters is required for a therapeutic

effect. "

Study Highlights

Sixty-eight patients were randomly assigned to either low-, medium-, or

high-dose branched-chain amino acids or placebo. The low- and medium-dose groups

were discontinued when an interim analysis failed to show any benefit from these

levels. Consequently, the efficacy portion of this trial is based solely on the

36 patients who completed the three weeks of high-dose treatment or placebo.

Efficacy was determined by measuring the frequency of dyskinesia movements on

a videotape.

From baseline to week 3, the amino acids group had a mean decrease of 36.5%

and the placebo group had a mean increase of 3.4% in tardive dyskinesia

movements.

One third of the subjects in the amino acid group had a reduction of 60% or

more in tardive dyskinesia movements. At week 3, the mean total tardive

dyskinesia movement count had decreased from 295 to 176 for the amino acid

group.

No clinically significant differences were seen between the pre- and

posttrial results of physical examinations and laboratory screening tests.

Minimal gastrointestinal symptoms occurred during the trial. The reduction of

tardive dyskinesia symptoms in the amino acid group was not related to changes

in antipsychotic and glucose plasma levels.

Pearls for Practice

Branched-chain amino acids are a safe and effective treatment for tardive

dyskinesia.

The reduction of tardive dyskinesia symptoms in the amino acids group is not

related to changes in antipsychotic and glucose plasma levels.

 

 

 

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