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Treatments and drugs
By Mayo Clinic staffDystonia treatment has improved in recent years, due to successes with botulinum toxin (Botox, Myobloc) injections. For more disabling cases, deep brain stimulation is now an option approved by the Food and Drug Administration.
Oral medications
Some forms of early-onset dystonia respond to levodopa and carbidopa (Parcopa, Sinemet) — a medication combination that increases brain dopamine, a neurotransmitter involved with muscle movement.
Dystonia prescriptions that act on other neurotransmitters include:
- Trihexyphenidyl
- Benztropine
- Diazepam (Valium)
- Lorazepam (Ativan)
- Clonazepam (Klonopin)
- Baclofen (Lioresal)
Possible side effects from these medications include drowsiness, dry mouth, constipation, blurred vision and confusion.
Sensory trick
A common phenomenon associated with dystonia is called a sensory trick. Touching an affected or adjacent body part can sometimes significantly reduce contractions. For example, placing a hand on the chin, side of the face or back of the head may reduce the muscle contractions of neck (cervical) dystonia. People with dystonia may discover and use this trick to reduce their own dystonic contractions.
Botulinum toxin
Botulinum toxin (Botox, Myobloc) blocks the release of a chemical messenger that triggers muscle contractions. When your doctor injects the toxin into a muscle, it causes that muscle to temporarily weaken, which may reduce or eliminate dystonic contractions. The effect wears off, and injections need to be repeated about every three months. Possible side effects from botulinum toxin depend on the site where it's injected, but may include excessive muscle weakness; if injected near the mouth or front of the neck, it may result in trouble swallowing.
Deep brain stimulation
This technique involves implanting an electrode in the brain and a stimulating device, connected to the electrode, implanted in the chest. The stimulator generates electrical pulses, transmitted via the implanted electrode into a specific brain region that reduces the abnormal muscle contractions. To modulate the effect of the treatment, your doctor can adjust the frequency and intensity of electrical pulses. Risks include infection, stroke-like problems, such as weakness or paralysis, and possible speech difficulties.
Surgery
Surgery is considered only in certain types of dystonia and when other treatments have not worked. With certain types of dystonia, surgeons can sever or remove the nerves controlling the contracted muscle. This may be done for eyelid dystonia (blepharospasm) or neck (cervical) dystonia.
- Dystonias fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/dystonias/detail_dystonias.htm. Accessed Jan. 21, 2010.
- Tarsy D, et al. Dystonia. New England Journal of Medicine. 2006;355:818.
- Comella C. Treatment of dystonia. http://www.uptodate.com/home/index.html. Accessed Jan. 18, 2010.
- Schwarz CS, et al. Genetics and treatment of dystonia. Neurologic Clinics. 2009;27:697.
- Dystonias. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec16/ch221/ch221c.html. Accessed Jan. 21, 2010.
- Ropper AH, et al. Abnormalities of movement and posture caused by disease of the basal ganglia. In: Ropper AH, et al. Adams and Victor's Principles of Neurology. 9th ed. New York, N.Y.: McGraw-Hill Medical; 2009. http://www.accessmedicine.com/content.aspx?aID=3630437. Accessed Jan. 21, 2010.
- Complementary therapy. Dystonia Medical Research Foundation. http://www.dystonia-foundation.org/pages/complementary_therapy/156.php. Accessed Jan. 22, 2010.
- Ahlskog EJ (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 27, 2010.
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