Therapeutic effects of flunitrazepan in dystonias and torticollis preliminary communication

Abstract

SUMMARY -A new form of clinical treatment is proposed for dystonias and torticollis using flunitrazepan (FN), a powerful agonist of all benzodiazepine receptors of GABA neurons. FN has a specific effect in dystonic patients, specially those in which the hypnotic effect of this drug is absent or diminished, thus suggesting the existence of two different neurochemical categories of dystonias.KEY WORDS: dystonia, torticollis, flunitrazepan, benzodiazepine receptors.Efeitos terapêuticos do flunitrazepan em distonias e torcicolo: comunicação preliminar.RESUMO -Nova forma de tratamento clínico é proposta para distonias e torcicolo usando flunitrazepan (FN), poderoso agonista de todos os receptores benzodiazepí nicos de neurônios GABA. FN tem efeito específico em pacientes diatónicos, especialmente naqueles em que o efeito hipnótico dessa droga está ausente ou diminuído, sugerindo assim a existência de duas diferentes categorias neuroquímicas de distonias. PALAVRAS-CHAVE: distonia, torcicolo, flunitrazepan, receptores benzodiazepines.Dystonia is a form of striatal familial dyskinesia transmitted in a recessive autosomical way, clinically manifested by several symptoms as: segmental dystonias, torsion spasms or attitudinal tremor. These symptoms may be influenced pharmacologically by certain drugs like dopamine and anticholinergic antiparkinsonian drugs. It is well-known that the majority of the benzodiazepine group has no specific effects on dystonias, although they are commonly prescribed.Patients. Results. Since 1973 we have observed a group of 35 patients, who have been submitted to varying doses of a currently used hypnotic drug: Flunitrazepan (FN) RO 5-4200, which, differently from other benzodiazepines we found as having definite and specific effects on dystonia and torticollis cases. A detailed study of the latter 15 cases using the Fahn-Marsden movement and disability scale 1 and video-recording, has shown that there is an inverse correlation between the hypnotic effects of this medication and its antidystonic action. Thus, the patients that had a good response, with amelioration of their dystonic syndrome did not show the typical somnolence as expected normally with the use of FN. On the contrary, some have presented an insomnia effect. According to the Fahn-Marsden scale these patients have reached a statistical level of amelioration between 32 and 100%. The lower amelioration rates