Neurológia pre prax 6/2009

Treatment of dystonias

Dystonia is characterized by sustained muscle contractions frequently causing repetitive twisting movements or abnormal postures. Based on the distribution of the symptoms, we classify the dystonias as focal, segmental, multifocal and generalized. Majority of dystonic syndromes is idiopathic, differential diagnosis of the secondary forms of dystonias is always needed. There is increasing knowledge about the genetics of dystonias lately. Treatment of dystonias was regarded as complicated and limited. The various drugs were used (antiepileptic, cholinergic, dopaminergic as well as antidopaminergic drugs) were introduced in the treatment with limited efficacy and increased side effects. Some patients underwent surgical procedures (selective peripheral denervation and myectomy, dorsal rhizotomy, stereotactic lesions in the basal ganglia) with different outcome. Botulinum toxin A is currently the treatment of choice in the management of focal dystonias. Botulinum toxin B is reserved for patients with botulinum toxin A failure (the occurence of the antibodies against botulinum toxin A). Deep brain stimulation is more widely used for generalized dystonias and focal dystonias refractory to botulinum toxin treatment when indication criteria were met.

Keywords: botulotoxin, DBS, dystonia, levodopa, tetrabenazine.