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Treatment

Treatment of focal and segmental dystonias such as spasmodic torticollis and blepharospasm

Treatment is given mainly with the active substance botulinum toxin. It has the effect of weakening or paralyzing muscle activity and inhibits the pathological hyperactivity of the affected muscles.

Depending on the clinical picture involved, the condition is treated by neurologists, ophthalmologists, orthopedic surgeons and speech therapists. Treatment is at present given in practices and clinics specialized in treatment with botulinum toxin.

In particular severe individual cases, doctors and patients may choose surgical procedures in which nerve connections are severed, for example. Careful thought must be given before embarking on these procedures, particularly in children and adolescents, since they are still growing. In adults, complications and aggravated symptoms may occur (e.g. with the Achilles tendon).

However, these operations may be associated with many risks and side effects, which is why they have so far been restricted to exceptional cases.

Some patients benefit from physiotherapy or other physical therapies, such as speech therapy for laryngospasm. There are also various forms of psychiotherapy which can help patients to cope better with their disease and the reactions of those around them.

Treatment of generalised dystonias

With generalized dystonia, botulinum toxin is not necessarily the treatment of first choice. Systemic medications such as L-dopa, baclofen, anticholinergics or benzodiazepines are generally used here. It may be possible to alleviate symptoms in a circumscribed area by means of local injections of botulinum toxin. In severe cases intrathecal baclofen therapy or deep brain stimulation may be considered.

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Dystonia at work

• Those affected often have acceptance problems

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