Treatments
Unfortunately, there is not yet a cure for most forms of dystonia. Nowadays, however, many dystonic
conditions can be very successfully managed.
What forms of treatment are available?
A variety of treatments is available for dystonia. These will be determined depending upon the type and
severity of the particular condition. The main options are:
- drug therapy
- injections of botulinum toxin
- surgery
DRUGS
Drugs are effective for some patients. Some work by interfering with neurotransmitters, the chemical
substances that carry messages within the brain. Others are designed to relax the muscles, reduce shaking
and control muscle spasms. To be effective, they have to be taken continuously. The following drugs could
be prescribed: trihexyphenidyl (formerly known as benzhexol); benzatropine (formerly known as benztropine);
diazepam; clonazepam; baclofen; carbamazepine; levodopa; tetrabenazine. Those drugs which have been
used in the past but are rarely used nowadays include: bromocriptine; chlorpromazine; haloperidol; pimozide;
amantadine.
Please note that from 1st June 2004, some drugs have new names: check with your pharmacist or doctor if
you have any problems obtaining your repeat prescriptions. One drug affected is benzhexol which is
now known as trihexyphenidyl.
More information about prescription drugs available in the UK can be accessed at:
www.medicines.org.uk
BOTULINUM TOXIN
Botulinum toxin injections are generally the most effective treatment for dystonia where it affects the
muscles of the neck or around the eyes. In some cases, other forms of dystonia (e.g. laryngeal and writer’s
cramp) can benefit from the treatment. The substance injected is a purified botulinum toxin. It works by
acting on the junctions between nerves and muscles, preventing the release of one of the chemical
messengers – acetylcholine – from the nerve endings. This reduces muscle contractions and causes the
overactive muscles to weaken. The nerve endings recover after eight or nine weeks, and so the treatment
has to be repeated, usually after a three-month interval. Any side effects are rarely serious and always
temporary.
SURGERY
Surgery may be an option for patients who have not responded to other treatments. (Resistance to
botulinum can build in a minority of patients over a period of time.) Surgical treatments include selective
denervation for cervical dystonia, and pallidotomy, thalamotomy or deep brain stimulation (DBS) for more
severe forms of dystonia. In the case of DBS, electrodes are planted in the basal ganglia to help ‘rebalance’
movement and to control posture, and is showing promising results for some forms of childhood onset
generalised dystonia.