Prescription Medications
The following medications are often given to individuals suffering from dystonia. They must be prescribed by a physician and taken under clinical supervision.
Anticholinergics
benzotropine, biperidin, ethopropazine, ophenadrine, procyclidine, trihexyphenidyl
Dopaminergics
levodopa, pramipexole, ropinirole, tetrabenazine
GABAergics
alprazolam, baclofen, chlordiazepoxide, clonazepam, diazepam
Muscle “relaxants”
baclofen, benzodiazepines, carisoprodol, chlorzoxazone, cyclobenzeprine, metaxolone, methocarbamol, orphenadrine
Others
carbamazepine, cannabidiol, cyproheptidine, gabapentin, lithium, mexilitine, nabilone, riluzole, tizanidine, zolpidem
Medical Therapies for Specific Dystonias
Many of following disorders occur in infancy, childhood or adolescence. They must be ruled out as a cause of dystonia and, if present, they must be treated medically.
Abetalipoproteinemia (Bassen-Kornzweig)
Onset at childhood to early adulthood, progressive oromandibular or generalized dystonia, ataxia, chorea, retinitis pigmentosa, fat malabsorption. Treated with vitamin E, reduced fat diet.
Aromatic amino acid decarboxylase deficiency
Onset in infancy, generalized dystonia with developmental delay, hypotonia, oculogyric crises, autonomic dysfunction. Treated with dopamine agonists, monoamine oxidase inhibitors.
Ataxia with vitamin E deficiency
Onset in childhood to early adulthood, rarely patients present with dystonia instead of ataxia or neuropathy. Treated with vitamin E.
Autoimmune movement disorders
Onset at any age, focal or generalized dystonia, systemic signs of autoimmune disease. Treated by addressing the autoimmune process.
Biotinidase deficiency
Onset in infancy, generalized dystonia with developmental delay, encephalopathy, seizures, sensory defects, skin rash. Treated with biotin.
Cerebral folate deficiency
Onset in early childhood to adolescence, progressive dystonia with developmental delay, neuropsychiatric syndromes, seizures. Treated with folinic acid.
Cerebrotendious xanthomatosis
Onset in late childhood to adulthood, oromandibular or limb dystonia, neurocognitive defects, spasticity, myoclonus, tendon xanthomas. Treated with chenodeoxycholic acid.
Cobalamin deficiencies (inherited sub-types A-G)
Onset in infancy, generalized dystonia with developmental delay, ataxia, spasticity, seizures, bone marrow defects. Treated with cobalamin derivatives and/or protein restriction.
CoEnzyme Q10 deficiency
Onset at any age, some cases present with dystonia and ataxia, affects varied phenotypes, most often progressive ataxia or encephalopathy. Treated with coenzyme Q10.
Cerebral creatine deficiency type 3
Onset in infancy, generalized dystonia with developmental delay, myopathy. Treated with creatine.
Dopa-responsive dystonia, classic
Onset in early childhood to late adulthood, generalized dystonia also known as Parkinsonism. Treated with levodopa.
Dopa-responsive dystonia, complicated
Onset in infancy to adolescence, generalized dystonia, hypokinetic-rigid syndrome, oculogyric crises, autonomic dysfunction. Treated with levodopa, 5-hydroxytryptophan, and/or tetrahydrobiopterin.
Dystonia with brain manganese accumulation
Onset in childhood, progressive generalized dystonia, Parkinsonism, liver disease, polycythemia. Treated with chelation therapy.
Galactosemia
Onset in childhood to early adulthood, mild focal or generalized dystonia, ataxia, tremor, food intolerance. Treated with lactose restriction.
GLUT1 deficiency
Onset in childhood to adolescence, paroxysmal exertional dystonia, developmental delay, seizures. Treated with ketogenic diet.
Glutaric aciduria type 1
Onset in early childhood to early adulthood, static generalized dystonia following encephalopathic crisis, developmental delay, encephalopathic crisis. Treated aggressively with focus on any inter-current illness, lysine restriction.
Homocystinuria
Onset in childhood, generalized or paroxysmal dystonia, neurocognitive dysfunction, myopia, ectopic lens. Treated with methionine restriction.
Guanidinoacetate methyltransferase deficiency
Onset in infancy, progressive generalized dystonia, developmental delay, seizures. Treated with arginine restriction, creatine and ornithine.
"Maple syrup" urine disease
Onset in childhood, focal or paroxysmal dystonia, neonatal encephalopathy, ataxia. Treated with leucine restriction, ±thiamine.
Methylmalonic aciduria
Onset in childhood, static generalized dystonia following encephalopathic crisis, developmental delay, encephalopathic crisis, renal insufficiency, pancytopenia. Treated aggressively with focus on any inter-current illness, protein restriction.
Molybdenum cofactor deficiency (sulfite oxidase)
Onset in adolescence, rarely patients present with dystonia and parkinsonism, developmental delay, encephalopathy, seizures. Treated with cyclic pyranopterin monophosphate.
Niemann Pick type C
Onset in early childhood to early adulthood, progressive generalized dystonia, dementia, ataxia, spasticity, seizures, supranuclear gaze palsy. Treated with N-butyl-deoxynojirimycin (Miglustat™).
Paraneoplastic movement disorders
Onset at any age, rapidly progressive focal or generalized dystonia, cancer malignancy, often occult. Treated by addressing the underlying malignancy.
Propionic aciduria
Onset in early childhood to adolescence, static generalized dystonia following encephalopathic crisis, developmental delay, encephalopathic crisis, optic atrophy, pancytopenia. Treated aggressively focusing on any inter-current illness, protein restriction.
Pyruvate dehydrogenase deficiency
Onset in infancy, progressive generalized or paroxysmal dystonia, developmental delay, seizures. Treated with thiamine, ketogenic diet, dichloroacetate.
Rapid onset dystonia-Parkinsonism
Onset in early childhood to late adulthood, bulbar or generalized dystonia following encephalopathic crisis, psychomotor disability. Treated aggressively with focus on any inter-current illness, protein restriction.
Wilson’s disease
Onset in early childhood to late adulthood, progressive generalized dystonia, neurocognitive dysfunction, liver disease, Kayser-Fleischer rings. Treated with zinc, tetrathiomolybdenate.
Complementary Therapies
The following complementary therapies are available to individuals suffering from dystonia. They must be administered by trained practitioners or licensed clinicians.
Acupuncture
It involves insertion of fine needles. Acupuncture stimulates the nerves in the skin, muscle and other tissues, and can produce a variety of effects.
Hypnosis
It is a psychological technique used in medicine as a tool to bring about positive changes to both the mind and the body. It is often accompanied by deep physical relaxation, increased inner focus and a corresponding reduction in the awareness of your surroundings.
Reflexology
It involves applying pressure to the feet and hands. The application of pressure to parts of the feet or the hands effect corresponding parts of the body through reflex zones and meridian points.
Autogenic Training (Meditation)
It is a structured meditative-style practice. It is a sequence of simple mental exercises which bring about profound mental and physical relaxation.
Homeopathy
It is based on the idea of treating ‘like with like’. Key features of homeopathy include: Holism (‘treating the person, not the disease’), Constitution (focusing on the type of person, including build, personality, general physical features), Idiosyncrasy (focus on what is unusual about the patient and their health problem), Minimum dose (concentrated tinctures to extremely diluted medicines).
Craniosacral Therapy
It is a gentle ‘hands-on’ therapy that aims to release tensions, restrictions and misalignments in the body.