Perspectives on the pharmacological management of dystonia

ABSTRACT

Introduction: Treatment of dystonia is particularly complex due to various etiologies and heterogeneous clinical manifestation, as well as different degrees of disability. In absence of causative treatment, all symptomatic therapy should be predominantly tailored to ameliorate those symptoms (motor and non/motor) that mostly affect patients’ daily life and regular activities. Many different treatment options, including oral medications, neurosurgical interventions, physical and occupational therapy are available in treatment of dystonia.

Areas covered: The aim of this perspective is to point out different possibilities in pharmacological management of dystonic movements. Due to pure clinical presentation, the authors concentrate mainly on the isolated dystonias, which are presented solely as dystonic movements. Combined and complex dystonias are not instructive due to compound clinical presentation and consequently, complicated treatment. The article is based on a literature search from sources including PubMed, the Cochrane Library, Web of Science, PiCarta, and PsycINFO.

Expert opinion: Although dystonia therapy should be adapted according to the individual needs, severity, age, type, symptoms distribution and acceptable side-effect profile, certain principles should be followed to reach the optimal result. Furthermore, the authors believe that a better understanding of the pathophysiology of dystonia will bring with it the development of new and improved treatment approaches and medications.

KEYWORDS:

• Botulinum toxin injections
• dystonia
• pharmacological management

Article highlights

• Treatment of dystonia is complex due to its clinical and etiological heterogeneity, with variable levels of functional disability.

• In absence of causative treatment, the symptomatic therapy should be predominantly tailored to ameliorate motor and non-motor symptoms that mostly affect patients’ activities of daily living.

• The therapy should be personalized and adapted according to the individual needs, age, severity and type of dystonia, and acceptable side-effect profile.

• Oral medications are mostly used in childhood and adolescent-onset dystonia, particularly in cases of generalized muscle involvement.

• Botulinum toxin is the first line treatment for focal and segmental dystonia, with possible new formulations that are expected to increase the duration of beneficial effects.

Declaration of interest

V Kostic has received speaker’s honoraria from Roche and Alkaloid and receives research support from Swiss Pharmaceutical Co. Ltd, the Serbian Ministry of Education, Science and Development and the Serbian Academy of Sciences and Art. The author(s) have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by the Ministry of Education, Science and Technological Development of the Republic of Serbia, Grant No. 175090 (to V Kostic).