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]