What is the role of the pyramidal and extrapyramidal systems in the pathophysiology of tardive dyskinesia (TD)?

Answer

The pyramidal system, controlling voluntary movements, includes precise anatomic pathways from the cortex to muscle. Voluntary movements through the pyramidal systems are visible. An example of a classic disorder of the pyramidal system is a stroke, resulting in paralysis of an extremity.

Corticospinal lesions above the pyramidal decussation typically result in paralysis of volitional movements of the contralateral half of the body and a fixed posture with flexion of the upper extremity and extension of the lower extremity. Bilateral corticospinal lesions of the upper pons and midbrain typically cause extension of all 4 extremities and decerebrate rigidity with dorsiflexion of the cervical and thoracolumbar spine. Unilateral lesions of the upper pons and midbrain often result in extension of the ipsilateral arm and leg.

By contrast, extrapyramidal motor activities result in automatic movement and static, postural movement activities that are not noticeable (see Table 1 below). The extrapyramidal system includes theorized connections within the basal ganglia, the striatopallidonigral system, and other structures of the central nervous system that contribute to the regulation of movement, including related brainstem nuclei and the cerebellum.

Table 1. Classic Characterization of Pyramidal and Extrapyramidal Systems (Open Table in a new window)

Characteristic	Pyramidal	Extrapyramidal
Anatomy	Precisely demarcated pathways from cortex to muscle	Hypothesized pathways among basal ganglia and other structures of the central nervous system
Physiologic movements	Voluntary	Involuntary
Pathologic movements	Paralysis, paresis, hyperreflexia, and spasticity	Akathisia, athetosis, ballismus, chorea, dystonia, myoclonus, stereotypy, tic, and tremor

Classic disorders of the extrapyramidal system include a variety of involuntary movement disorders. Some of these movement disorders include dyskinesias such as akathisia, chorea, dystonia, myoclonus, stereotypy, tic, and tremor.

The pathophysiology of extrapyramidal disorders has been disputed on the grounds that some of these disorders may not involve lesions of the basal ganglia and, in addition, may not be involuntary. Because of the problems inherent in the concept of the extrapyramidal system, caution must be exercised in the classification of movement disorders as EPSs, and new approaches to the classification of movement disorders may be helpful.

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Al Hadithy AF, Ivanova SA, Pechlivanoglou P, Semke A, Fedorenko O, Kornetova E, et al. Tardive dyskinesia and DRD3, HTR2A and HTR2C gene polymorphisms in Russian psychiatric inpatients from Siberia. Prog Neuropsychopharmacol Biol Psychiatry. 2009 Apr 30. 33(3):475-81. [Medline].
Liou YJ, Lai IC, Liao DL, Chen JY, Lin CC, Lin CY, et al. The human dopamine receptor D2 (DRD2) gene is associated with tardive dyskinesia in patients with schizophrenia. Schizophr Res. 2006 Sep. 86(1-3):323-5. [Medline].
Bakker PR, van Harten PN, van Os J. Antipsychotic-induced tardive dyskinesia and the Ser9Gly polymorphism in the DRD3 gene: a meta analysis. Schizophr Res. 2006 Apr. 83(2-3):185-92. [Medline].
Lafuente A, Bernardo M, Mas S, Crescenti A, Aparici M, Gassó P, et al. Dopamine transporter (DAT) genotype (VNTR) and phenotype in extrapyramidal symptoms induced by antipsychotics. Schizophr Res. 2007 Feb. 90(1-3):115-22. [Medline].
Galecki P, Pietras T, Szemraj J, Florkowska K, Florkowski A, Zboralski K. [Functional polymorphism of manganese superoxide dismutase (MnSOD) gene correlates with schizophrenia in Polish population]. Pol Merkur Lekarski. 2006 Mar. 20(117):329-32. [Medline].
Rizos EN, Chatziioannou S, Douzenis A, Siafakas N, Katsantoni E, Nikolaidou P, et al. Signs of striatal dopamine transporter density increase in association with improvement of tardive dyskinesia in a patient with schizophrenia, as demonstrated by a DAT scan. Eur Neuropsychopharmacol. 2010 Feb. 20(2):132-6. [Medline].
Bordia T, McIntosh JM, Quik M. Nicotine Reduces Antipsychotic-Induced Orofacial Dyskinesia in Rats. J Pharmacol Exp Ther. 2011 Dec 5. [Medline].
Tan YL, Zhou DF, Zhang XY. Decreased plasma brain-derived neurotrophic factor levels in schizophrenic patients with tardive dyskinesia: association with dyskinetic movements. Schizophr Res. 2005 May 1. 74(2-3):263-70. [Medline].
Modestin J, Wehrli MV, Stephan PL, Agarwalla P. Evolution of neuroleptic-induced extrapyramidal syndromes under long-term neuroleptic treatment. Schizophr Res. 2008 Mar. 100(1-3):97-107. [Medline].
Bishnoi M, Chopra K, Kulkarni SK. Protective effect of Curcumin, the active principle of turmeric (Curcuma longa) in haloperidol-induced orofacial dyskinesia and associated behavioural, biochemical and neurochemical changes in rat brain. Pharmacol Biochem Behav. 2008 Feb. 88(4):511-22. [Medline].
Bishnoi M, Chopra K, Kulkarni SK. Involvement of adenosinergic receptor system in an animal model of tardive dyskinesia and associated behavioural, biochemical and neurochemical changes. Eur J Pharmacol. 2006 Dec 15. 552(1-3):55-66. [Medline].
Yoshida K, Bies RR, Suzuki T, Remington G, Pollock BG, Mizuno Y, et al. Tardive dyskinesia in relation to estimated dopamine D2 receptor occupancy in patients with schizophrenia: analysis of the CATIE data. Schizophr Res. 2014 Mar. 153(1-3):184-8. [Medline]. [Full Text].
Fountoulakis KN, Panagiotidis P, Siamouli M, Kantartzis S, Mavridis T, Iacovides A, et al. Amisulpride-induced tardive dyskinesia. Schizophr Res. 2006 Dec. 88(1-3):232-4. [Medline].
Masdrakis VG, Papadimitriou GN, Papageorgiou C, Kouzoupis A, Giailoglou D, Soldatos CR. Development of tardive dyskinesia in a patient taking amisulpride. Prog Neuropsychopharmacol Biol Psychiatry. 2007 Mar 30. 31(2):586-7. [Medline].
Wei HT, Lai YW, Chen MH, Chen YS. Oral-paliperidone-induced tardive dyskinesia: a case report. Gen Hosp Psychiatry. 2011 Dec 8. [Medline].
Peritogiannis V, Tsouli S, Zafiris S, Pappas D, Mavreas V. Improvement of tardive dyskinesia following amisulpride treatment. Prog Neuropsychopharmacol Biol Psychiatry. 2006 Jun. 30(4):748-50. [Medline].
Brasic JR, Zagzag D, Kowalik S, Prichep L, John ER, Liang HG, et al. Progressive catatonia. Psychol Rep. 1999 Feb. 84(1):239-46. [Medline].
Brasic JR, Zagzag D, Kowalik S, Prichep L, John ER, Barnett JY, et al. Clinical manifestations of progressive catatonia. German Journal of Psychiatry [serial online]. 2000. 3(2):13-24. [Full Text].
Brasic JR. Conversion disorder in childhood. German Journal of Psychiatry [serial online]. 2002. 5 (2):54-61. [Full Text].
Brasic JR, Andrews SR, Housain B, Alexander M, Mohamed M. Characterization of zaghrouta, an expression of happiness in the Middle East, a component of the differential diagnosis of psychogenic disorders. [abstract]. The Movement Disorder Society, editor. 2nd International Conference on Psychogenic Movement Disorders and Other Conversion Disorders, April 2-4, 2009, L’Enfant Plaza Hotel, Washington, DC,. Abstract # 06. 78-79.
Brasic JR, Alexander M, Mohamed M. Differentiation of zaghrouta, an expression of happiness by women in the Middle East, from medical disease. [abstract]. South Med J. 2003;96 (10 supplement):S35.
Shinkai T, De Luca V, Hwang R, Matsumoto C, Hori H, Ohmori O, et al. Association study between a functional glutathione S-transferase (GSTP1) gene polymorphism (Ile105Val) and tardive dyskinesia. Neurosci Lett. 2005 Nov 11. 388(2):116-20. [Medline].
Tiwari AK, Deshpande SN, Rao AR, Bhatia T, Lerer B, Nimgaonkar VL, et al. Genetic susceptibility to tardive dyskinesia in chronic schizophrenia subjects: III. Lack of association of CYP3A4 and CYP2D6 gene polymorphisms. Schizophr Res. 2005 Jun 1. 75(1):21-6. [Medline].
Rizos EN, Siafakas N, Katsantoni E, Lazou V, Sakellaropoulos K, Kastania A, et al. Association of the dopamine D3 receptor Ser9Gly and of the serotonin 2C receptor gene polymorphisms with tardive dyskinesia in Greeks with chronic schizophrenic disorder. Psychiatr Genet. 2009 Apr. 19(2):106-7. [Medline].
Zai CC, Tiwari AK, Basile V, de Luca V, Müller DJ, Voineskos AN, et al. Oxidative stress in tardive dyskinesia: genetic association study and meta-analysis of NADPH quinine oxidoreductase 1 (NQO1) and Superoxide dismutase 2 (SOD2, MnSOD) genes. Prog Neuropsychopharmacol Biol Psychiatry. 2010 Feb 1. 34(1):50-6. [Medline].
Miura I, Zhang JP, Nitta M, Lencz T, Kane JM, Malhotra AK, et al. BDNF Val66Met polymorphism and antipsychotic-induced tardive dyskinesia occurrence and severity: a meta-analysis. Schizophr Res. 2014 Feb. 152(2-3):365-72. [Medline]. [Full Text].
Goetz DG. Tardive dyskinesia. Watts RL, Koller WC, eds. Movement Disorders: Neurologic Principles and Practice. Blackwell Publishing; 1997. 519-526.
Yassa R, Lal S, Korpassy A, Ally J. Nicotine exposure and tardive dyskinesia. Biol Psychiatry. 1987 Jan. 22(1):67-72. [Medline].
Connor DF, Fletcher KE, Wood JS. Neuroleptic-related dyskinesias in children and adolescents. J Clin Psychiatry. 2001 Dec. 62(12):967-74. [Medline].
Go CL, Rosales RL, Caraos RJ, Fernandez HH. The current prevalence and factors associated with tardive dyskinesia among Filipino schizophrenic patients. Parkinsonism Relat Disord. 2009 Nov. 15(9):655-9. [Medline].
[Guideline] Bhidayasiri R, Fahn S, Weiner WJ, Gronseth GS, Sullivan KL, Zesiewicz TA. Evidence-based guideline: treatment of tardive syndromes: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013 Jul 30. 81(5):463-9. [Medline].
Brasic JR, Barnett JY, Lafargue RT. The classification of stereotypies and other movement disorders in persons with autism. Recueil des Resumes, Quatrieme Conference de la Federation Internationale des So. 1993. 72-73.
Brasic JR, Barnett JY, Sheitman BB, Lafargue RT, Ahn SC. Clinical assessment of adventitious movements. Psychol Rep. 1998 Dec. 83(3 Pt 1):739-50. [Medline].
Brasic JR, Fuman JW, Conte RM. Continuous quality improvement in child and adolescent psychopharmacology. Child and Adolescent Psychophamacology News. June 1999. 4(3):9-10.
Brasic JR, Kisnad HV, Leven LI, Nettleton JW, Arzola JL, Zhou Y. Quality assurance of the community placement of institutional residents. German Journal of Psychiatry [serial online]. 2002. 5 (4):95-114. [Full Text].
Brasic JR, Barnett JY, Zelhof R, Tarpley H. Dopamine antagonists ameliorate the dyskinesias, aggression, and inattention of persons with mental retardation referred to psychiatric clinics. German Journal of Psychiatry [serial online]. 2001. 4(1):9-16. [Full Text].
Brasic JR, Furman J, Conte RM, Baisley WE, Jaslow RI. Assuring the quality of the utilization of psychoactive medication by people with mental retardation and developmental disabilities by assessing dosages. German Journal of Psychiatry [serial online]. 2000. 3(3):7-12. [Full Text].
Brasic JR, Barnett JY, Kowalik S, Tsaltas MO, Ahmad R. Neurobehavioral assessment of children and adolescents attending a developmental disabilities clinic. Psychol Rep. 2004 Dec. 95(3 Pt 2):1079-86. [Medline].
Aripiprazole improves neuroleptic-associated tardive dyskinesia, but it does not meliorate psychotic symptoms. Prog Neuropsychopharmacol Biol Psychiatry. 2008 Jul 1. 32(5):1342-3. [Medline].
Brasic JR, Zhou Y, Musachio JL, Hilton J, Fan H, Crabb A, et al. Single photon emission computed tomography experience with (S)-5-[(123)I]iodo-3-(2-azetidinylmethoxy)pyridine in the living human brain of smokers and nonsmokers. Synapse. 2009 Apr. 63(4):339-58. [Medline]. [Full Text].
Brasic JR, Furman JW, Conte RM, Baisley WE, Jaslow RI. Assessing the quality of the administration of psychoactive medication. J Dev Phys Disabil. 2003. 15:185-205.
Brasic JR, Young JG, Furman J. Psychoactive Medication Quality Assurance Rating Survey (PQRS). J Dev Phys Disabil. 9. 1997:311-336.
Brasic JR, Furman JW, Conte RM, Baisley WE, Jaslow RI. Psychoactive Medication Quality Assurance Rating Survey (PQRS) Screening Criteria. J Dev Phys Disabil. 2003. 15:231-253.
Wong DF, Brasic JR, Singer HS, Schretlen DJ, Kuwabara H, Zhou Y, et al. Mechanisms of dopaminergic and serotonergic neurotransmission in Tourette syndrome: clues from an in vivo neurochemistry study with PET. Neuropsychopharmacology. 2008 May. 33(6):1239-51. [Medline].
Kuo SH, Jankovic J. Tardive gait. Clin Neurol Neurosurg. 2008 Feb. 110(2):198-201. [Medline].
Abnormal Involuntary Movement Scale (AIMS). Psychopharmacol Bull. 1988. 24(4):781-3. [Medline].
Barnes TR. A rating scale for drug-induced akathisia. Br J Psychiatry. 1989 May. 154:672-6. [Medline].
Fleischhacker WW, Bergmann KJ, Perovich R, Pestreich LK, Borenstein M, Lieberman JA, et al. The Hillside Akathisia Scale: a new rating instrument for neuroleptic-induced akathisia. Psychopharmacol Bull. 1989. 25(2):222-6. [Medline].
Sachdev P. A rating scale for acute drug-induced akathisia: development, reliability, and validity. Biol Psychiatry. 1994 Feb 15. 35(4):263-71. [Medline].
Wu JQ, Chen da C, Tan YL, Tan SP, Wang ZR, Xiu MH, et al. Cognition impairment in schizophrenia patients with tardive dyskinesia: association with plasma superoxide dismutase activity. Schizophr Res. 2014 Jan. 152(1):210-6. [Medline].
Campbell M. Timed Stereotypies Rating Scale. Psychopharmacol Bull. 1985. 21(3):1082.
Wong DF, Gründer G, Brasic JR. Brain imaging research: does the science serve clinical practice?. Int Rev Psychiatry. 2007 Oct. 19(5):541-58. [Medline].
Wong DF, Maini A, Rousset OG, Brasic JR. Positron emission tomography--a tool for identifying the effects of alcohol dependence on the brain. Alcohol Res Health. 2003. 27(2):161-73. [Medline].
Chatziioannou SN, Rizos EN. Human Brain Imaging in Tardive Dyskinesia. Seeman P, Madras B. Imaging of the human brain in health and disease. 1. Oxford, UK: Academic Press, Elsevier; 2014. 361-371.
Chatziioannou SN, Rizos EN, Kallergi M, Douzenis A, Apostolopoulos A, Bacalis S, et al. Tardive dyskinesia related to quetiapine and confirmed by a DAT scan. J Clin Psychopharmacol. 2011 Aug. 31(4):535-8. [Medline].
Thobois S, Poisson A, Damier P. Surgery for tardive dyskinesia. Int Rev Neurobiol. 2011. 98:289-96. [Medline].
Zesiewicz TA. Tardive dyskinesia. Neurology Now. April/May 2014. 10 (2):35. [Full Text].
[Guideline] American Academy of Neurology. TREATMENT OF TARDIVE SYNDROMES. www.aan.com. Available at https://www.aan.com/Guidelines/Home/GetGuidelineContent/613. Accessed: May 16, 2014.
Hauser RA, Factor SA, Marder SR, Knesevich MA, Ramirez PM, Jimenez R, et al. KINECT 3: A Phase 3 Randomized, Double-Blind, Placebo-Controlled Trial of Valbenazine for Tardive Dyskinesia. Am J Psychiatry. 2017 Mar 21. appiajp201716091037. [Medline].
Anderson KE, Stamler D, Davis MD, Factor SA, Hauser RA, Isojärvi J, et al. Deutetrabenazine for treatment of involuntary movements in patients with tardive dyskinesia (AIM-TD): a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Psychiatry. 2017 Aug. 4 (8):595-604. [Medline]. [Full Text].
Fernandez HH, Factor SA, Hauser RA, Jimenez-Shahed J, Ondo WG, Jarskog LF, et al. Randomized controlled trial of deutetrabenazine for tardive dyskinesia: The ARM-TD study. Neurology. 2017 May 23. 88 (21):2003-2010. [Medline]. [Full Text].
Fukasawa T, Takahashi M, Otani K. A successful clonazepam treatment without tolerance in a patient with spontaneous oral dyskinesia. Prog Neuropsychopharmacol Biol Psychiatry. 2001 Oct. 25(7):1477-80. [Medline].
Thaker GK, Nguyen JA, Strauss ME, Jacobson R, Kaup BA, Tamminga CA. Clonazepam treatment of tardive dyskinesia: a practical GABAmimetic strategy. Am J Psychiatry. 1990 Apr. 147 (4):445-51. [Medline].
Ertugrul A, Demir B. Clozapine-induced tardive dyskinesia: a case report. Prog Neuropsychopharmacol Biol Psychiatry. 2005 May. 29(4):633-5. [Medline].
Richardson MA, Bevans ML, Read LL, Chao HM, Clelland JD, Suckow RF, et al. Efficacy of the branched-chain amino acids in the treatment of tardive dyskinesia in men. Am J Psychiatry. 2003 Jun. 160(6):1117-24. [Medline].
Aquino CC, Lang AE. Tardive dyskinesia syndromes: current concepts. Parkinsonism Relat Disord. 2014 Jan. 20 Suppl 1:S113-7. [Medline].
Lin CC, Bai YM, Chen JY, Wang YC, Liou YJ. Treatment of clozapine-associated tardive dyskinesia. Prog Neuropsychopharmacol Biol Psychiatry. 2008 Feb 15. 32(2):599-600. [Medline].
Miyaoka T, Furuya M, Yasuda H, Hayashida M, Nishida A, Inagaki T, et al. Yi-gan san for the treatment of neuroleptic-induced tardive dyskinesia: an open-label study. Prog Neuropsychopharmacol Biol Psychiatry. 2008 Apr 1. 32(3):761-4. [Medline].
Alexander J, Bickerstaff S. Aripiprazole induced tardive dyskinesia--accruing evidence. Aust N Z J Psychiatry. 2013 Mar. 47 (3):289-90. [Medline].
Ono S, Suzuki Y, Shindo M, Endo T, Fukui N, Sugai T, et al. Improvement of tardive dyskinesia and dystonia associated with aripiprazole following a switch to quetiapine: case report and review of the literature. J Clin Pharm Ther. 2011 Oct 24. [Medline].
Slotema CW, van Harten PN, Bruggeman R, Hoek HW. Botulinum toxin in the treatment of orofacial tardive dyskinesia: a single blind study. Prog Neuropsychopharmacol Biol Psychiatry. 2008 Feb 15. 32(2):507-9. [Medline].
van Harten PN, Kahn RS. Tardive dystonia. Schizophr Bull. 1999. 25(4):741-8. [Medline].
Sugawara N, Yasui-Furukori N, Kaneko S. Improvement of tardive dyskinesia following zopiclone treatment. Prog Neuropsychopharmacol Biol Psychiatry. 2009 Jun 15. 33(4):727-8. [Medline].
Bishnoi M, Chopra K, Kulkarni SK. Progesterone attenuates neuroleptic-induced orofacial dyskinesia via the activity of its metabolite, allopregnanolone, a positive GABA(A) modulating neurosteroid. Prog Neuropsychopharmacol Biol Psychiatry. 2008 Feb 15. 32(2):451-61. [Medline].
Iwata Y, Irie S, Uchida H, Suzuki T, Watanabe K, Iwashita S, et al. Effects of zonisamide on tardive dyskinesia: A preliminary open-label trial. J Neurol Sci. 2012 Jan 27. [Medline].
[Guideline] American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed. (DSM-IV). 4. Washington, DC: American Psychiatric Association; 1994.
Achalia RM, Chaturvedi SK, Desai G, Rao GN, Prakash O. Prevalence and risk factors associated with tardive dyskinesia among Indian patients with schizophrenia. Asian J Psychiatr. 2014 Jun. 9:31-5. [Medline].
Ivanova SA, Geers LM, Al Hadithy AF, Pechlivanoglou P, Semke AV, Vyalova NM, et al. Dehydroepiandrosterone sulphate as a putative protective factor against tardive dyskinesia. Prog Neuropsychopharmacol Biol Psychiatry. 2014 Apr 3. 50:172-7. [Medline].
[Guideline] Lerner V, Miodownik C, Sheva B, et al. Evidence-based guideline: Treatment of tardive syndromes: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013 Nov 26. 81(22):1967. [Medline].

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Diagnostic criteria for neuroleptic-induced tardive dyskinesia.
Tardive dyskinesia. Venn diagram of the classification of movement disorders.

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Author

James Robert Brasic, MD, MPH Assistant Professor, Russell H Morgan Department of Radiology and Radiological Science and Neurology, Division of Nuclear Medicine and Molecular Imaging, Johns Hopkins University School of Medicine

James Robert Brasic, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Neurology, International Parkinson and Movement Disorder Society, Society for Neuroscience

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Johns Hopkins University School of Medicine Received research grant from: National Institutes of Health, Johns Hopkins University School of Medicine, Intellectual & Developmental Disabilities Research Center (U54 HD079123) at the Kennedy Krieger Institute Received income in an amount equal to or greater than $250 from: Brand Institute, Inc. Received royalty from Medscape for other; Received royalty from Neuroscience-Net, LLC for other; Received grant/research funds from National Institutes of Health for other.

Chief Editor

Selim R Benbadis, MD Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida Morsani College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, American Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Ceribell, Eisai, Greenwich, Growhealthy, LivaNova, Neuropace, SK biopharmaceuticals, Sunovion Serve(d) as a speaker or a member of a speakers bureau for: Eisai, Greenwich, LivaNova, Sunovion Received research grant from: Cavion, LivaNova, Greenwich, Sunovion, SK biopharmaceuticals, Takeda, UCB.

Acknowledgements

Brian Bronson, MD Staff Physician, Department of Psychiatry, New York University Medical Center

Disclosure: Nothing to disclose.

Tristen T Chun Division of Nuclear Medicine, Russell H Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine

Disclosure: Nothing to disclose.

Nestor Galvez-Jimenez, MD, MSc, MHA Chairman, Department of Neurology, Program Director, Movement Disorders, Department of Neurology, Division of Medicine, Cleveland Clinic Florida

Nestor Galvez-Jimenez, MD, MSc, MHA is a member of the following medical societies: American Academy of Neurology, American College of Physicians, and Movement Disorders Society

Disclosure: Nothing to disclose.

Daniel H Jacobs MD, FAAN, Associate Professor of Neurology, University of Florida College of Medicine; Director for Stroke Services, Orlando Regional Medical Center

Daniel H Jacobs is a member of the following medical societies: American Academy of Neurology, American Society of Neurorehabilitation, and Society for Neuroscience

Disclosure: Teva Pharmaceutical Grant/research funds Consulting; Biogen Idex Grant/research funds Independent contractor; Serono EMD Royalty Speaking and teaching; Pfizer Royalty Speaking and teaching; Berlex Royalty Speaking and teaching

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

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