Medical treatment of dystonia

Abstract

Therapeutic strategies in dystonia have evolved considerably in the past few decades. Three major treatment modalities include oral medications, botulinum toxin injections and surgical therapies, particularly deep brain stimulation. Although there has been a tremendous interest in the later two modalities, there are relatively few recent reviews of oral treatment. We review the medical treatment of dystonia, focusing on three major neurotransmitter systems: cholinergic, GABAergic and dopaminergic. We also provide a practical guide to medication selection, therapeutic strategy and unmet needs.

Pharyngeal Dystonia Misdiagnosed as Cricopharyngeal Dysphagia Successfully Treated by Pharmacotherapy

“…Clonazwww.e-arm.org epam, a benzodiazepines, binds to GABA A receptors, facilitating inhibitory neurotransmission. However, the role of gabapentin, a GABA agonist, in pathophysiology of dystonia still remains unclear [7]. From the perspective of rehabilitation medicine, significant improvements in depression and dysphagia were noted after the patient received medication.…”

“…Pharmacotherapy was tested for the management of dystonia. Administration of basic treatment drugs for dystonia [7], Trihexin 2 mg (trihexyphenidyl HCl; Tai Guk Pharm Co. Ltd., Seoul, Korea), Rivotril 0.5 mg (clonazepam; Roche Inc., Basel, Switzerland), and Neurontin 100 mg (gabapentin; Pfizer Inc., NY, USA) were started three times a day. One week after drug administration, mTDS showed significant improvement from 9 to 4 points.…”

Medical treatment of dyskinetic cerebral palsy: translation into practice

“…In movement disorder practice, the therapeutic approach to dystonia and chorea is different. Most commonly employed oral pharmacological therapies in dystonia include anticholinergics, especially trihexyphenidyl, baclofen, and clonazepam . In contrast, medical treatment of chorea includes presynaptic dopamine depletors, especially vesicular monoamine transporter 2 (VMAT2) inhibitors such as tetrabenazine, and postsynaptic dopamine receptor blockers (or neuroleptics).…”

“…Importantly, contradictory results of levodopa efficacy in dyskinetic CP were generally derived after exclusion of alternative diagnoses including dopa‐responsive dystonia (DRD). In clinical practice, levodopa trials still have a crucial role diagnostic confirmation, since DRD is a ‘don't‐miss’ treatable disorder with expanding phenotypic spectrum …”

“…In clinical practice, levodopa trials still have a crucial role diagnostic confirmation, since DRD is a 'don't-miss' treatable disorder with expanding phenotypic spectrum. 1 Lessons from dystonia provide some insights for future clinical trials. Regarding trihexyphenidyl, high dosage (after slow titration) and adequate duration of treatment (up to several weeks) may be required.…”