From the Guidelines
Dystonia treatment should prioritize botulinum toxin injections for focal dystonias, as they have been shown to be highly effective in improving voice quality and quality of life, with a preponderance of benefit over harm 1. Dystonia is a movement disorder characterized by involuntary muscle contractions that cause abnormal postures or repetitive movements.
Treatment Options
- First-line medications include anticholinergics like trihexyphenidyl and benzodiazepines such as clonazepam.
- Botulinum toxin injections are highly effective for focal dystonias, administered every 3-4 months directly into affected muscles.
- For generalized dystonia, oral baclofen or intrathecal baclofen pumps may be used.
- Deep brain stimulation targeting the globus pallidus internus is an effective surgical option for medication-resistant cases.
Occupational Therapy
- Encouraging optimal postural alignment at rest and within function, considering a 24-hour management approach, is crucial for dystonia management 1.
- Grade activity to increase the time that the affected limb is used within functional activities.
- Avoid postures that promote prolonged positioning of joints at the end of range.
- Strategies that reduce muscle overactivity, pain, and fatigue, such as muscle relaxation strategies, should be employed.
Key Considerations
- Early treatment is important to prevent complications like contractures and chronic pain.
- The condition may be primary (genetic or idiopathic) or secondary to brain injury, medication side effects, or other neurological conditions.
- Physical therapy, occupational therapy, and stress management techniques complement medical treatment.
- Dystonia occurs due to dysfunction in the basal ganglia, which normally coordinates smooth movement patterns. The most recent and highest quality study 1 provides a Grade B recommendation with high confidence in the evidence, supporting the use of botulinum toxin injections for the treatment of spasmodic dysphonia, a type of focal dystonia.
From the Research
Definition and Types of Dystonia
- Dystonia is a movement disorder characterized by involuntary muscular contractions that generate twisting and repetitive movements and/or abnormal postures 2
- It can affect a few muscle groups (focal dystonia) or spread to most muscles in the body (generalized dystonia) 2
- Focal dystonia affects a single part of the body, while generalized dystonia can affect most or all of the body 3
Treatment Options for Dystonia
- Botulinum toxin therapy is used to treat a large number of muscle hyperactivity syndromes, including dystonia 4
- Deep brain stimulation (DBS) is becoming the standard of care for medically intractable, disabling dystonias 2
- Other treatment options include oral anticholinergics, baclofen, clonazepam, and novel drugs such as sodium oxybate, zonisamide, and perampanel 5
- Noninvasive neuromodulation procedures and simultaneous rehabilitation techniques may also improve outcomes 5
Effectiveness and Safety of Treatments
- Botulinum toxin therapy has a peripheral paresis which is localized, well controllable, and follows a distinct and predictable time course of around 3 months 4
- Adverse effects of botulinum toxin therapy are always transient and usually mild, and long-term application is safe 4
- DBS has advantages such as reversibility, adjustability, and continued access to the therapeutic target 2
- A systematic review found 19 studies that met the inclusion criteria, and the quality of evidence for interventions was evaluated using GRADE 3