Current Treatment Options in Neurology

, Volume 14, Issue 3, pp 213–229 | Cite as

Treatment of Focal Dystonia

Movement Disorders (O Suchowersky, Section Editor)
First Online:

Opinion statement

Dystonia is characterized by repetitive twisting movements or abnormal postures due to involuntary muscle activity. When limited to a single body region it is called focal dystonia. Examples of focal dystonia include cervical dystonia (neck), blepharospasm (eyes), oromandibular dystonia, focal limb dystonia, and spasmodic dysphonia, which are discussed here. Once the diagnosis is established, the therapeutic plan is discussed with the patients. They are informed that there is no cure for dystonia and treatment is symptomatic. The main therapeutic option for treating focal dystonias is botulinum toxin (BoNT). There have been several attempts to characterize the procedure, the type of toxin, dosage, techniques, and combination with physical measures in each of the focal dystonia forms. The general treatment principles are similar. The affected muscles are injected at muscle sites based on evidence and experience using standard dosages based on the type of toxin used. The injections are repeated after 3 to 6 months based on the individual response duration. In the uncommon event of nonresponse with BoNT, the dose and site are reassessed. Oral drug treatment could be considered as an additional option. Once the condition is thought to be medically refractory, the opinion from the deep brain stimulation (DBS) team for the suitability of the patient for DBS is taken. The successful use of DBS in cervical dystonia has led to increased acceptance for trial in other forms of focal dystonias. DBS surgery in focal dystonias other than cervical is, however, still experimental. The patients may be offered the surgery with adequate explanation of the risks and benefits. Patient education and directing the patients towards dystonia support groups and relevant websites that provide scientific information may be useful for long-term compliance and benefit.

Keywords

Focal dystonia Treatment Botulinum toxin Anticholinergics Deep brain stimulation 
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Notes

Disclosure

A. Batla: none. M. Stamelou: none. K.P. Bhatia has received research support from Ipsen and from the Halley Stewart Trust through Dystonia Society UK, and the Wellcome Trust MRC strategic neurodegenerative disease initiative award (Ref. number WT089698), a grant from the Dystonia Coalition, and a grant from Parkinson’s UK (Ref. number G-1009). He has received personal compensation for scientific advisory board for GlaxoSmithKline and Boehringer Ingelheim, and royalties from the publication of Oxford Specialist Handbook of Parkinson’s Disease and Other Movement Disorders (Oxford University Press, 2008). He has also received funding for travel from GlaxoSmithKline, Orion Corporation, Ipsen, and Merz Pharmaceuticals, LLC, and received speaker honoraria from GlaxoSmithKline, Ipsen, Merz Pharmaceuticals, LLC, and Sun Pharmaceutical Industries Ltd.

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Amit Batla
    • 1
  • Maria Stamelou
    • 1
  • Kailash P. Bhatia
    • 1
  1. 1.The National Hospital for Neurology and Neurosurgery Queen SquareLondonUK

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