Dystonia treatment

Dystonia can be treated on an outpatient basis by neurological specialists or in a special center (movement outpatient clinic). There are several options available for this. Which therapy is suitable depends primarily on the form of the disease:

Injections with botulinum toxin

Focal dystonia with its various forms only affects individual muscles or muscle groups. In these cases, local (topical) injection treatment may be useful. This involves injecting tiny amounts of botulinum toxin, also known as “Botox”, into the most severely affected muscles using a fine injection needle. The drug is obtained from a bacterial toxin (Clostridium botulinum). The treatment interrupts the transmission of nerve impulses. This weakens the affected muscle. This reduces the cramps and movement disorders. The effect sets in after a few days and lasts for about three months. It must then be repeated. This type of therapy is particularly suitable for torticollis, eyelid spasm and vocal cord spasm.

Treatment with medication

For patients with generalized dystonia or patients with focal dystonia who do not respond adequately to treatment with botulinum toxin, various medications can be considered:

• Anticholinergics: They act on the central nervous system and have an antispasmodic effect.
• Antiepileptic drugs: If anticholinergics are not successful, other medications can be used. These include drugs for epilepsy (antiepileptic drugs).
• Levodopa: Drugs for Parkinson’s disease such as levodopa or L-dopa can also be used.

The dosage and combination of medication should always be individualized. Overall, the importance of drug treatment for dystonia has decreased due to deep brain stimulation.

Surgical treatment

Surgery is always considered if injection treatment or drug therapy is unsuccessful, causes too many side effects and therefore severely restricts the quality of life of those affected. In the procedures commonly used in the past, the doctor cut the nerves of the affected muscles. A newer and promising method is deep brain stimulation. The surgeon implants an electrode and a pulse generator in the brain – similar to a pacemaker. This suppresses the pathological information by means of electrical impulses. The method is particularly suitable for severe generalized idiopathic dystonia – i.e. forms of the disease that affect large parts of the body and whose cause is unknown – but is also used for focal dystonia that cannot be treated sufficiently well.

Further therapy options

Physiotherapy can help to prevent or alleviate misalignments as a supplementary measure. Last but not least, psychotherapy can be useful in order to better cope with social and emotional problems caused by the disease.