Available treatment options for dystonia

Introduction: Dystonia is a neurologic movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures, or both. The etiology of dystonia is diverse and it includes genetic and other causes. Since the advent of botulinum toxin and deep brain stimulation, the treatment of dystonia has markedly improved and is still evolving. Areas covered: This review gives a historical overview of the treatment options for dystonia. In the absence of pathogenesis-targeted, disease-modifying therapies, the treatment of dystonia remains symptomatic. Botulinum toxin is the first line treatment for some forms of focal and segmental dystonias. Oral medications, including anticholinergics, baclofen, benzodiazepines and antidopaminergic drugs are used primarily in patients with generalized dystonia. Levodopa is an effective treatment for patients with dopa-responsive-dystonia. The use of deep brain stimulation, intrathecal and intraventricular baclofen, as well as ablative surgeries are options for patients with disabling dystonia refractory to other, less invasive, therapies. Expert opinion: The selected treatment modality should be tailored to the patient's needs and guided by potential side effects. Refractory cases should be referred to tertiary center for evaluation with a multidisciplinary team and potential surgical treatment.