Secondary dystonias

Hartmann, Andreas; Pogarell, Oliver; Oertel, W. H.

doi:10.1007/s004150050235

Cited by 36 publications

(23 citation statements)

References 20 publications

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“…20,46 Spasticity is more common than dyskinesia, and CP is the most common cause of this upper motor neuron syndrome in children. 37,38 However, not all patients with spasticity are candidates for treatment, and a careful consideration of functional status and other impairments is imperative for each individual.…”

Section: Discussionmentioning

confidence: 99%

Indwelling intrathecal catheter with subcutaneous abdominal reservoir: a viable baclofen delivery system in severely cachectic patients

Waqar

Ellenbogen²,

Kumar³

et al. 2014

PED

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Intrathecal baclofen (ITB) is a reversible treatment that reduces muscle tone to ameliorate spasticity and dystonia in patients with cerebral palsy (CP). The resulting decrease in energy expenditure allows patients to gain much-needed weight, albeit temporarily. Modern techniques require sufficient abdominal musculature and subcutaneous fat to permit the implantation of an indwelling pump. In patients with extremely low muscle bulk, visceral pumps may be impractical or impossible, with increased risks of dehiscence and infection. The authors describe a variation of the classical procedure in a young patient with severe cachexia. A 10-year-old boy with spastic-dystonic quadriplegic CP was admitted to the neuromedical unit. Numerous drug trials had failed, and surgical intervention was deemed necessary but was complicated by his cachectic body habitus. The authors inserted a lumbar intrathecal catheter and subcutaneously tunneled it to the anterolateral abdomen, where it was connected to a subcutaneous injection port. Baclofen was continuously infused into the subcutaneous port using a noncoring needle connected to an external pump. The needle and line were changed every 5 days to minimize the risk of sepsis. Although other techniques, such as intraventricular baclofen delivery, have been described, these are largely dependent upon sufficient musculature to support a visceral pump. A subcutaneous injection port system represents an alternative approach that reduces the risk of sepsis and may be better tolerated in cachectic patients.

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Section: Discussionmentioning

confidence: 99%

Indwelling intrathecal catheter with subcutaneous abdominal reservoir: a viable baclofen delivery system in severely cachectic patients

Waqar

Ellenbogen²,

Kumar³

et al. 2014

PED

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“…In fact, many drugs produce dystonic reactions by nigrostriatal dopaminereceptor blockade, which leads to an excess of striatal cholinergic output [4, 5]. Paradoxically, an alternative cause of dystonic reactions may be increased nigrostriatal dopaminergic activity that occurs as a compensatory response to dopamine receptor blockade as occurs with selective SSRIs.…”

Section: Introductionmentioning

confidence: 99%

“…However, patients have been successfully treated with other medications including antiparkinson agents, benzodiazepines, caffeine, phenobarbital and diphenhydramine hydrochloride [4, 7]. …”

Section: Introductionmentioning

confidence: 99%

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Oculogyric Dystonic Reaction to Escitalopram with Features of Anaphylaxis Including Response to Epinephrine

Patel

Simon²

2006

Int Arch Allergy Immunol

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Dystonia-associated features of anaphylaxis, including tongue swelling, and chest and throat tightness, have been rarely reported with selective serotonin reuptake inhibitor (SSRI) use. The patient is a 44-year-old woman who presented with palpitations, diaphoresis, dyspnea, swelling of the lips and tongue, and fixed upward deviation of her right eye following inadvertent ingestion of 20 mg of escitalopram in addition to her usual 10-mg dose. She reported transient resolution of all symptoms after autoinjector aqueous epinephrine administration (0.3 mg), with recurrence of symptoms after 35 min. The patient presented with one prior episode of anaphylactic symptoms and dystonia. She also reported one episode with purely anaphylactic features of swelling of lips and tongue, difficulty breathing and syncope. This case represents a unique dose-dependent episode of escitalopram-associated oculogyric dystonia with anaphylactic features. The transient resolution of the associated features of dystonia with intramuscular epinephrine administration is unique and suggests a common pathophysiology of the dystonic and anaphylactic symptoms.

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“…Dystonia may be classified etiologically into idiopathic dystonia, secondary dystonia, dystonia-plus syndrome and heredodegenerative dystonia. Secondary dystonia may occur due to various causes, such as cerebral palsy (CP), including perinatal anoxic or hypoxic-ischemic damage, meningitis, traumatic brain injury, reactions to medications and unknown genetic factors [2]. The treatment of secondary dystonia depends on the main symptoms, causes, severity and disabilities of patients, and can include pharmacologic therapy, chemodenervation, botulinum toxin injection or surgery [3,4].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Bilateral Globus Pallidus Internus Deep Brain Stimulation plus Ventralis Oralis Thalamotomy on Patients with Cerebral Palsy

Kim

Chang

Cho

et al. 2012

Stereotact Funct Neurosurg

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Objective: We compared bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) with bilateral GPi DBS plus ventralis oralis (Vo) thalamotomy to analyze the effect of the combined Vo thalamotomy. Methods: Between March 2003 and December 2008, 10 patients underwent DBS and/or Vo thalamotomy for treatment of cerebral palsy in our institute of neurosurgery and rehabilitation medicine. Four patients received bilateral posteroventral GPi DBS as group I and 6 patients received GPi DBS plus unilateral thalamotomy as group II. Results: The movement and disability scores of group I improved by 32 and 14.3%, respectively, at the last follow-up compared with baseline. The movement and disability scores of group II improved by 31.5 and 0.18%. The BFMDRS-movement subscores of group II demonstrated statistically significant improvement in the contralateral arm compared to group I (p = 0.042). Body pain, vitality and mental health seemed to improve in group II, in terms of health-related quality of life. Conclusions: Contrary to our expectations, we were unable to demonstrate clear improvements in overall BFMDRS scores between group I and group II. However, movements of the contralateral upper extremities improved and health-related quality of life in group II showed satisfactory results.

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Secondary dystonias

Cited by 36 publications

References 20 publications

Indwelling intrathecal catheter with subcutaneous abdominal reservoir: a viable baclofen delivery system in severely cachectic patients

Indwelling intrathecal catheter with subcutaneous abdominal reservoir: a viable baclofen delivery system in severely cachectic patients

Oculogyric Dystonic Reaction to Escitalopram with Features of Anaphylaxis Including Response to Epinephrine

The Effect of Bilateral Globus Pallidus Internus Deep Brain Stimulation plus Ventralis Oralis Thalamotomy on Patients with Cerebral Palsy

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