The treatment depends on the cause of the dystonia. Treating the underlying condition in cases of secondary dystonia may improve the symptoms. There are three approaches to the treatment of dystonia, depending on the region of the body affected and the severity of the symptoms: medications, botulinum toxin injections and surgery. Physical therapy may be helpful as a supplement to other therapies.
Botulinum toxin injections:
Botulinum toxin injections are the treatments of choice for most forms of focal dystonia. The toxin is produced by the bacterium that causes botulism. When a small amount of commercially prepared toxin is selectively injected in the overactive muscles, it causes a change in the muscle firing, calming the abnormal movements for up to several months at a time.
Segmental, multifocal and generalized dystonia are usually treated with oral medications. These include anticholinergic drugs (trihexyphenidyl or Artane®, benztropine or Cogentin®) and muscle relaxants or antispastic agents (diazepam or Valium®, clonazepam or Klonopin®, baclofen or Lioresal®). In addition, specific forms of dystonia can respond to particular medications. For example, dopa-responsive-dystonia is treated with levodopa (Sinemet®).
Patients with widespread or severe debilitating dystonia can benefit from surgery if they are unresponsive to other treatments. The most widely used current surgical approach is called deep brain stimulation, or DBS. In this surgery, thin electrodes are implanted into a part of the basal ganglia called the globus pallidus and are attached to a pacemaker-like device implanted in the chest wall. These electrodes deliver controlled electrical pulses that can have a marked improvement of dystonia symptoms, especially for patients with generalized primary dystonia. Please visit our FAQs page to find out more information about surgical treatments such as DBS.
Adjuvant therapy is an important component in the treatment of dystonia. Regular daily stretching exercises are a vital component to maintaining mobility, range of motion and flexibility. Physical therapy plays an important role in patients with cervical dystonia, usually as a supplement to other therapies such as botulinum toxin injections. Braces and other orthotics may be helpful for some patients by taking advantage of “sensory tricks” that involve touching a particular part of the body to relieve symptoms. Biofeedback techniques have been studied as adjuvant therapies in dystonia, although long-term benefits have not been shown. Many patients report beneficial effects and symptom relief from other complimentary therapies such as yoga, tai chi and meditation techniques, although rigorous studies evaluating their efficacy are lacking.