Approaches to Treatment
The first step in treatment is attempting to determine the cause of the dystonia. For secondary dystonias, treating the underlying cause may improve the dystonia. For instance, treatments for neurological conditions such as multiple sclerosis or Parkinson's disease may reduce dystonic symptoms. Withdrawing or reducing neuroleptic drugs leads to slow improvement in some cases.
There are three main approaches to the treatment of dystonia: oral medications, injections of therapeutic agents directly into dystonic muscle, and surgery. Physical therapy may play a role for some patients, most often as a supplement to other therapies such as botulinum toxin. Supportive therapy provides an important adjunct to medical treatment for many patients. There are currently no known treatments that can reverse the course of primary dystonia. However, symptoms may usually be managed well with a combination of treatments.
For example, patients with dopa-responsive dystonia (DRD) improve significantly with small doses of levodopa. Neurologists often try a course of levodopa therapy for patients with limb-onset dystonia in order to determine if DRD is the cause. Most patients who do not have DRD will not have a strong response to levodopa or to other dopaminergic drugs, such as dopamine agonists.
Support and advocacy organizations are important resources for individuals with dystonia and their families. Newsletters, group meetings, and Internet-based discussion groups offer opportunities for sharing of information, exchanging psychological support, and becoming involved in promoting research on dystonia and its treatments. A full list of international support and advocacy groups is available here.