Dystonia involves involuntary contraction of muscles that normally work in cooperation so that a body part is held in an unusual and often painful position as a result. Dystonia can affect any body part and can result in both embarrassment and the inability to perform daily activities. Fortunately, there are a number of different ways that dystonia can be improved.
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Physical and Occupational Therapy
Oral Medications
Unfortunately, few medications are completely effective for the treatment of dystonia. Exceptions to this rule include the use ofBenadrylto treat acute drug-induced dystonia and the use of dopamine to treat certain forms of inherited dystonia, such as Segawa syndrome. For this reason, all children or adolescents who have dystonia should be given a trial of dopamine.
Artane (trihexyphenidyl) is one of the best-studied medications for dystonia. This medication is from the family of anticholinergics. Younger patients tend to benefit most from this medication. Adults may be more sensitive to the side effects of anticholinergics, including dry mouth, confusion, sedation, memory loss, and hallucinations.
Benzodiazepines, like clonazepam, may also be used, usually in conjunction with another medication as well. Baclofen, a muscle relaxant, is generally not very helpful in the treatment of dystonia but may be useful in treating leg dystonia, especially among children. The main side effect of these medications is sedation.
Dopamine-depleting agents like tetrabenazine are the exact opposite of giving dopamine, but can also have a place in treating dystonia. Side effects include depression and dysphoria, as well as parkinsonism. If these medications are used, the doses should only be increased very slowly.
Injected Medications
Infocal dystoniaaffecting only one part of the body, injections of botulinum toxins may be helpful. In fact, in some kinds of dystonia, such as blepharospasm (excessive eye blinks) and cervical torticollis (neck dystonia), botulinum toxin injection is considered the first-line therapy. In torticollis, 70-90% of patients reported some benefit. Injections are repeated every 12 to 16 weeks. Under this treatment plan, the effects can remain robust and safe for many years.
Surgical Options
When medical options fail and if the dystonia is truly impairing someone’s life, surgical options may be considered.
Deep brain stimulation is most indicated for medically refractory primary generalized dystonia. The people who suffer from this type of dystonia tend to be young, including children. Responses to deep brain stimulation can vary widely. In general, the response of dystonia to DBS is less predictable than the response ofParkinson’sdisease and essential tremor, and the improvement may only be seen many months after treatment.
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