Generalised Dystonia or Segmental Dystonia

Diagnosis:

Clinical features:

  • Segmental: to adjacent regions
  • Mutifocal: nonadjacent regions
  • Hemidystonia: ipsilateral arm & leg
  • Generalised: leg +trunk +another region

Trial of levodopa, 2 months long to rule out dopa responsive dystonia.

Treatment:

Trial of levodopa, 2 months long. This should be tried in all childhood onset dystonias
Anticholinergics: e.g. Trihexyphenidyl
Others:

  • Clonazepam, Baclofen or Carbamazepine CBZ
  • Diazepam
  • Phenothiazines: haloperidol, tetrabenazine

Consider:

  • Local Botulinum toxin injection
  • Bilateral pallidal deep-brain stimulation [SPIDY, small prospective]

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