DYSTONIA

:smokin HELP ME TO FIND MORE MANAGEMENT IN SECONDARY DYSTONIA

Hi,
My client is having Dystonia following by stroke . iam tired of thinking and finding a good article to reduce dystonia.can any body help me?

Have a look on these sites on the internet for valuable help. I shall tell you in more detail later on.

www.dystonia.ie

www.dystonia-support4u.co.uk

www.sitestogo.biz/home/dystonia/6

www.brainaustralia.org.au/ AZ_of_Brain_Disorders/dystonia

www.dystonia-europe.org/europe/Article_Long_term_03.htm

brain.oupjournals.org/cgi/content/short/127/10/2360

These will be of help to you.

Physical therapy techniques (eg, massage), slow stretching, and physical modalities (eg, ultrasonography and biofeedback) are sometimes helpful in focal or regional dystonias. Patients with generalized dystonia often benefit from gait and mobility training and instruction in the use of assistive devices.

Various physical therapies and modalities have been used with limited success in the symptomatic treatment of dystonias. These include relaxation training, sensory stimulation, biofeedback, transcutaneous electrical nerve stimulation, and percutaneous dorsal column stimulation. Stretching and bracing may aid in preventing or reducing the contractures associated with prolonged abnormal positions, especially when used in conjunction with the medical treatments previously described

Occupational therapy is important for training for activities of daily living (ADLs) and the proper positioning and seating in patients whose mobility is impaired. Adaptive equipment should be provided to enhance function.

Speech therapists can offer training and communication aids to patients with oromandibular or laryngeal dystonia, and they can help in preventing complications in patients with transient dysphagia resulting from botulinum toxin injections.

Vocational rehabilitation may aid individuals in job retraining or in adapting to the workplace, as appropriate

Physiatric procedures:

Neurochemolysis of dystonic muscles is the second line of therapeutic options. Botulinum toxin has become a powerful therapeutic tool in improving the symptomatic treatment of focal dystonias, and it appears to be the treatment of choice for blepharospasm, cervical dystonia, and hemifacial spasm. The neurotoxin is produced by the gram-negative bacterium Clostridium botulinum, and it acts by irreversibly inhibiting the presynaptic release of acetylcholine at the neuromuscular junction. Of the 7 immunologically distinct serotypes, only type A is approved for clinical use. More recently, type B has been approved.

The local injection of botulinum toxin into the offending muscles, typically the sternocleidomastoid, trapezius, and splenius capitis, has been successful and not associated with significant complications. In a few cases, dysphagia developed because of local spread of the toxin to neighboring pharyngeal and laryngeal muscles. The doses vary depending on the bulk of the target muscle and the desired clinical effect; they range from 50 units for small muscles to a maximum recommended dose of 400 units in large muscles. The number of injection sites per muscle varies similarly; generally, 2-6 sites are selected.

The selection of appropriate muscles should be based on careful clinical assessment of the maximally involved muscles and on a clear delineation of the goals (eg, improved function, hygiene, pain relief). Initial needle placement in the chosen muscle is based on anatomic landmarks, with electromyelographic (EMG) localization of muscle twitch at 2-3 mA. The onset of clinical effect is observed within 1-3 days, and the peak physiologic effect occurs at 2-6 weeks after the injections. The duration of effect varies from 4 weeks to 6 months; repeated injections are required to maintain the therapeutic effect in most patients.

The adverse effects of botulinum toxin injections are generally transient and related to local weakness or pain in occasional patients or to the development of antibodies that lead to resistance. The other major limitation at this point is the high cost of ongoing botulinum toxin therapy and the associated reimbursement issues.


Medications for Dystonias:

Medications are prescribed in early stages and have some effects in controlling the dystonic movements. The current lack of knowledge of the exact pathophysiology of dystonia has made the definition of specific pharmacologic therapies difficult. Systemic pharmacologic therapy benefits about one third of patients and consists of a wide variety of medications, including cholinergics, benzodiazepams, antiparkinsonism drugs, anticonvulsants, baclofen, carbamazepine, and lithium.

Successful drug therapy often requires combinations of these medications, with choices generally guided by empirical trials and adverse effect profiles. Doses should be slowly increased over the course of weeks or months until the therapeutic benefit is optimized or until adverse effects occur. In most patients, discontinuation of the drugs requires tapering to prevent withdrawal symptoms.

Intrathecal baclofen therapy is another promising intervention. This is an alternate therapy to oral medication when adverse effects and overdosing become a challenge.