Treatment Strategies for Dystonia: Medical and Surgical
TREATMENT STRATEGIES FOR DYSTONIA: MEDICAL and SURGICAL was presented at the Spring 2010 American Academy of Neurology
H. A. Jinnah, MD PhD
Emory University School of Medicine
Atlanta, GA 30307
The clinical manifestations of the dystonias are extremely varied. Dystonias occur in children and adults. They may involve one body region or many. They may be progressive, static, task-specific, or paroxysmal. The causes of these varied clinical manifestations are equally varied. Dystonias may be inherited or acquired, with a broad array of known underlying biological mechanisms. Considering the clinical and etiological heterogeneity, it is not surprising that responses to different treatments also vary widely. The heterogeneity makes the design of a universal treatment algorithm challenging.
Although systematic and evidence-based reviews for treatments of dystonia have been published,[1-3] many commonly used treatments have not been subject to rigorous clinical trials. Much evidence comes from small controlled trials, unblinded or uncontrolled observations, retrospective reviews, or anecdotal reports, and personal experience. In the absence of definitive evidence, recommendations regarding treatments reflect a combination of all available evidence combined with the experience of providers who treat large numbers of dystonia patients.
Multiple lengthy reviews covering treatments for dystonia have been published already.[4-8] This summary was developed as a practical synopsis and is organized into three parts. The first part provides a synopsis of the most common treatment options available, both medical and surgical. The second part provides a synopsis of how the diagnosis of different types of dystonia influences the selection of treatment options. The third part includes a summary and conclusions, along with future goals for the development and testing of novel therapies.
Available Treatment Options:
Treatment Stratrgies for Different Populations:
