TREATMENT STRATEGIES FOR DYSTONIA: MEDICAL and SURGICAL was presented at the Spring 2013 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. The dystonias may involve one body region or many. They may occur in children or adults. 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 underlying biological mechanisms. With all the clinical and etiological heterogeneity, it is not surprising that responses to treatments also vary widely. The heterogeneity makes the design of a universal treatment algorithm for all dystonias 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, non-blinded trials or uncontrolled observations, retrospective reviews, anecdotal reports, and personal experience. In the absence of definitive evidence, recommendations regarding treatments reflect a synthesis of the limited available evidence with the experience of providers who treat large numbers of dystonia patients. Thus treatment recommendations from different sources may vary.
Multiple lengthy reviews describing treatment recommendations for dystonia have been published.[4-8] This syllabus was developed as a practical synopsis and is organized into three parts. The first part provides a catalog of the most common treatment options available, both medical and surgical. The second part provides a summary of how the diagnosis of different types of dystonia influences the selection of these different treatment options. The third part includes a synthesis and conclusions, along with future goals for the development and testing of novel therapies.