Sir, Tardive dystonia (TDt) occurs in 0.4-4% of the persons treated with dopamine receptor-antagonists (DRAs), and differs from the more common tardive dyskinesia (TDk) with respect to clinical features, treatment and outcome. Dysphagia due to tardive pharyngeal dystonia has only been reported anecdotally. We report a case presenting with severe dystonic dysphagia due to TDt. A 61-year-old man was prescribed a combination of the DRA flupenthixol (0.5 mg) plus a tricyclic antidepressant, melitracen (10 mg) for nonspecific somatic complaints for short-term use. He however continued long-term use of the medication as symptomatic treatment for insomnia. Eighteen months later, he gradually developed involuntary orolingual movements causing slurring of speech. Intermittent opening of his mouth would cause spillage of food while eating and difficulty in talking. The movements progressed slowly over weeks and, 3 months later, in addition to trouble retaining food in his mouth, he noticed difficulty in swallowing solid food. A year later he could swallow only semi-solids or liquids [Video 1]. Around this time, he also noticed involuntary flexion of all fingers of his left hand and developed involuntary, forceful closure of both eyes. By three months before presentation, he was completely unable to swallow solids and liquids, necessitating placement of a nasogastric tube. He had lost 20 lbs over the last year. There was no history of mental illness or other systemic disease. Family history was negative for dystonia and unremarkable for other neurologic illness. On examination, bilateral blepharospasm and frequent, rhythmic lip pursing/puckering movements were seen, with intermittent tongue protrusion, jaw opening and side-to-side jaw movements [Video 2]. Speech was slurred and halting. Flexion dystonia of fingers of the left hand was evident. There was no other focal dystonia or Parkinsonism, and the rest of the neurological examination was normal.
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