For treatment to be effective, it is essential to understand the trigger or cause of the dystonia. Certain medications may be effective for some people but not for others. Some work by interfering with neurotransmitters and disrupting the messages sent to muscles by the brain. Others work by relaxing the muscles and so reduce shaking and aid control of muscle spasms.
Depending on the cause and severity of the dystonia, the strategies that the doctor may suggest include:
- a controlled release form of levodopa at night, to alleviate or prevent off- dystonia. This type of medication is released slowly over a four to six hour period and reduces the fluctuations in levodopa levels in the blood
- adding in a COMT inhibitor or dopamine agonist to improve the effectiveness of levodopa and reduce the likelihood of off-dystonia
- if dystonia does not respond to changes in Parkinson’s medication then muscle relaxants or benzodiazepines may be prescribed. These reduce communication between the brain and the nervous system. Alternatively anticholinergic medications can be used to prevent the release of the chemical messenger acetylcholine. A medication may also be prescribed to reduce the release of spinal neurotransmitters which stimulate muscles
- botulinum toxin can be injected into the affected muscle to block the release of the chemical messenger acetylcholine and prevent it from stimulating the muscle contractions. The injected muscles are weakened and so dystonic spasms are reduced, but the treatment needs to be repeated every two or three months to remain effective. Unfortunately some people develop a resistance to this treatment over a period of time
- surgical procedures, such as deep brain stimulation, thalamotomy and pallidotomy, have been found to be effective in managing dystonia in those who do not respond to medication. These are not appropriate for everyone so you will need to discuss these options with your doctor.
If the dystonia is levodopa-related, it is a good idea to keep a 'motor diary' to record when dystonic spasms occur and how they relate to the timing of medications. Your doctor should then be able to help in adjusting dosage and/or timings to manage your dystonia. For more information on such diaries, see Diary.
