The Symptomatic Treatment of Acquired Dystonia: A Systematic Review

Abstract

Background Acquired dystonia is caused by an acquired or exogenous event. Although the therapeutic armamentarium used in clinical practice is more or less similar to that used for inherited or idiopathic dystonia, formal proof of the efficacy of these interventions in acquired dystonia is lacking. Methods The authors attempt to provide a comprehensive and systematic review of the current evidence for medical and allied health care treatment strategies in acquired dystonias. The PubMed, Cochrane Library, MEDLINE, Web of Science, PiCarta, and PsycINFO databases were searched up to December 2015, including randomized controlled trials, patient‐control studies, and case series or single case reports containing a report on clinical outcome. Results There are level 3 practice recommendations for botulinum toxin injections and globus pallidus pars interna deep brain stimulation for tardive dystonia and dystonic cerebral palsy as well as intrathecal baclofen for dystonic cerebral palsy. There are insufficient and conflicting data on the effect (vs. the hazard) of other pharmacological interventions, and limited work has been done on other forms of neurostimulation and allied health care. Because no class A1 or A2 studies were identified, level 1 or 2 practice recommendations could not be deducted for a specific treatment intervention. Conclusions To improve the current medical and allied health care treatment options for patients with acquired dystonia, high‐quality trials that examine the efficacy of therapies need to be performed.

Defective Somatosensory Inhibition and Plasticity Are Not Required to Develop Dystonia

“…1 Treatment strategies and their outcomes also differ between dystonia subtypes. [2][3][4] Such features are consistent with the concept that different dystonias may have different neuroanatomical substrates 5 and pathophysiology. 6 Evidence for the latter comes from studies in the motor system.…”

Efficacy of oral pharmacological treatments in dyskinetic cerebral palsy: a systematic review

“…Two papers were conference contributions. Some of these studies have been discussed in a recent systematic review on the treatments of secondary dystonia …”

“…Some of these studies have been discussed in a recent systematic review on the treatments of secondary dystonia. 26 Among the different drugs tested over the years in dyskinetic CP, trihexyphenidyl (or other anticholinergic drugs) and levodopa were the most used and the best studied ones. A smaller number of articles reported on tetrabenazine, diazepam, dantrolene, and baclofen.…”

Deep Brain Stimulation and Thalamotomy for the Treatment of Dystonia Acquired by Moyamoya Disease with Stroke

“…Unilateral GPi-DBS combined with VIM/VOA thalamotomy results in less financial burden and less risks of side effects. Additionally, previous cases have reported the remarkable efficacy of both DBS and thalamotomy for severe idiopathic dystonia [16] and combined GPi and VIM-DBS for dystonic tremor [17]. In our case, for patient with acquired hemidystonia presenting mainly with dystonic tremor, we expected combining unilateral GPi-DBS with VIM/VOA thalamotomy to achieve maximized efficacy.…”