 One of the major limitations of conventional antipsychotics is their high propensity to cause extrapyramidal symptoms EPS. Tardive dyskinesia TD in particular causes problems, insofar as it is common, and resistant to treatment. TD is under-recognised in clinical settings. However, prevalence studies indicate that 5 of patients treated with conventional antipsychotics develop TD each year for the first eight years with an average reported prevalence rate in the region between 17 and 23. Although in the majority of cases the disorder is mild and not distressing, TD contributes to social and vocational impairment, as well as to the further stigmatization of the illness. A minority develop severe symptoms, which are extremely distressing and disabling, and may even be life-threatening. Treatment of TD is difficult. Dose-reduction or discontinuation of antipsychotic medication may paradoxically result in exacerbation of the TD symptoms, and also run the risk of precipitating a psychotic relapse. With the exception of clozapine and possibly botulinum toxin for tardive dystonia, vitamin E7 and vitamin B6, little evidence exists to indicate efficacy for any treatment modality for TD. 