The case described by Weetman et al 1 confirms the difficulty in managing drug induced (tardive) dyskinesia and dystonia, and suggests that posteroventral pallidotomy should be considered as a possible treatment option for this condition.

We report on a patient with similarly severe and refractory drug induced dystonia, and dyskinesia who responded to a right thalamotomy, a potentially safer surgical procedure than pallidotomy.2 3

A 66 year old right handed, retired newsagent had a long history of a bipolar affective disorder beginning at the age of 25 years. He had been treated with a combination of tricyclic antidepressant drugs, antipsychotic drugs, lithium carbonate, and electroconvulsive therapy. In 1993 his medication was changed from 25 mg thioridazine thrice daily to 2 mg trifluoperazine thrice daily (because of postural hypotension). Two months later the patient started to complain of abnormal neck movements associated with facial grimacing and neck pain. He …