Sometimes trauma to the head or neck area may cause slippage of the bony spine, particularly in a child. This is called atlantoaxial dislocation and may result in a picture which resembles spasmodic torticollis but is, in fact, not dystonia but an orthopedic problem.
Is there any correlation between general anesthetics and dystonia?
There is not a causal link between general anesthetics and dystonia. Certain types of medication can cause dystonia. The medications most frequently implicated include antipsychotic agents and certain medications used to treat nausea and vomiting. These agents can cause acute and reversible symptoms of dystonia at the time of administration, most often involving the eyes, face, jaw, oral muscles, neck and back, or can produce chronic dystonia following prolonged use, called tardive dystonia. Agents used as general anesthetics are not directly linked to dystonia.
Can the prolonged use of antihistamines, decongestants, or headache medicines cause dystonia?
The medications commonly used for the treatment of headache are not directly linked with dystonia. However, some of the medications used to treat the nausea and vomiting associated with migraine headaches, in particular, metoclopramide (Reglan), are known to cause acute reversible dystonic reactions and tardive dystonia. There have been rare, isolated instances in which antihistaminic agents have been associated with dystonia, which subsides following the discontinuation of the medication. Antihistaminic medications are actually used in some people to treat the symptoms of dystonia.
Could an allergic reaction to a drug cause dystonia?
The term "allergic" refers to an idiosyncratic response to a drug in which the body recognizes the drug as a foreign substance, and the immune system is activated to eliminate the offending agent. Typical allergic reactions to drugs include rash, hives, shortness of breath, dizziness, and light-headedness. Dystonia does not result from allergy to drugs. Prudence in the use of medications is always wise. People should not take medicines unless they have been informed of the risks and benefits of the proposed therapy.
If dystonia is not genetically caused (no family history known), what is the probable cause of childhood-onset and generalized dystonia?
The absence of a clear family history of dystonia does not rule out a hereditary basis for childhood-onset generalized dystonia. Explanations for this phenomenon include mild undiagnosed dystonia in family members and certain types of inheritance (autosomal recessive, X-linked recessive, reduced penetrance of autosomal dominant genes). All these may result in "skipped generations" or indeed in a completely negative family history. It is possible that breakthroughs in genetics may soon allow the diagnosis of hereditary dystonia even in families without a clear family history.
Other conditions may cause childhood-onset generalized dystonia. Some of these conditions are hereditary as well. They are discussed separately from hereditary onset generalized dystonia because they also cause other signs of neurologic dysfunction such as seizures, mental retardation, weakness, coordination, and other difficulties.
These conditions are diagnosed with various tests such as brain scanning, blood, urine, and other tests. Lastly, childhood-onset generalized dystonia may result from a brain damage resulting from head trauma, lack of brain oxygen, stroke, or exposure to toxin. Your doctor will determine to what extent testing should be performed to try to explain the occurrence of dystonia in childhood.
Can neurofibromatosis cause dystonia?
Yes, neurofibromatosis is a condition of many small brain tumors that may cause dystonia.
If you are not born with dystonia, what causes it to manifest itself later in life?
It is quite rare to see someone "born" with dystonia, manifesting symptoms at the time of birth. Childhood-onset dystonia associated with the inherited form of dystonia begins in early childhood after a period of normal physical development and often initially involves the leg and foot. In adult-onset dystonia, the onset is typically in the 40's following decades of normal physical function. The reason for the appearance of dystonia after initial normal development and function is not known. It is thought that in some people there are external factors which may trigger the dystonia, but specific triggers have not yet been identified.
Can dystonia be caused by a injury?
To date, there is some evidence to support a role of trauma including injury to the head or other body parts.It makes sense that if these factors can influence genetic forms of dystonia, they may also be important to other forms of primary dystonia where there is little or no genetic influence. Studies of these questions require accurate and detailed evaluations of the past histories of large numbers of patients as well as unaffected individuals or "controls." One reason for pursuing these issues is that it is well established that trauma does occasionally result in some forms of well-established "secondary" dystonia.
For example, closed head injury can sometimes result in severe dystonia. Typically in these cases, the injury has been severe enough to result in damage to the basal ganglia, which can be visualized on brain imaging studies. Direct injury to a limb may also result in severe dystonic postures. The mechanisms underlying this "peripheral injury-induced dystonia" are poorly understood.
It appears from the literature that people who are carriers of the gene for dystonia may be more likely to have trauma as a triggering factor for the development of dystonia. When people have an injury and then develop dystonia in that body part, you are tempted to say, "There must be some relationship between the trauma and the dystonia." There are legal aspects of trauma-induced dystonia that have to be dealt with as well. It's a gray area at this point. It may be that there is a triggering factor, but we're really not clear as to why some people who have the gene manifest the symptoms and some do not.
Is dystonia a sensory disorder?
On first appearance, dystonia is a movement disorder. It is characterized by abnormal postures and movements. Sensation seems normal. There are clues, however, that sensory function may not be completely normal and that sensory features are important. Since the sensory system is an important influence on the motor system, abnormalities of the sensory system could be relevant in causing motor dysfunction.
Sensory tricks can relieve a dystonic spasm. The most commonly noted is the "geste" in spasmodic torticollis where, for example, a finger placed lightly on the face will neutralize the spasm. Such tricks are seen in all forms of dystonia. Pressure on the eyelids might improve blepharospasm, a toothpick in the mouth might relieve tongue dystonia, and sensation applied to parts of the arm might improve a writer's cramp.
On the other hand, sensory stimulation might trigger dystonia. This might be called a reverse "geste." Examples include a tart taste producing tongue dystonia or a loud noise producing spasmodic torticollis.
Sensory symptoms may well precede the appearance of dystonia. Common examples would be a gritty sensation in the eye preceding blepharospasm and irritation of the throat preceding spasmodic dysphonia. Photophobia is an example of distorted sensation.
Abnormal sensory input might well be a trigger for dystonia. Trauma to a body part is often a precedent to dystonia of that part. A blow to the head might precede torticollis, irritations of the eye are common in blepharospasm, and a deep cut of the hand might occur just before writer's cramp develops.
There may be an important problem with the processing of muscle spindle input. In patients with hand cramps, vibration can induce the patient's dystonia. Cutaneous input similar to that which produces the sensory trick can reverse the vibration-induced dystonia. Conversely, both action-induced and vibration-induced dystonia can be improved with lidocaine block of the muscle, which will reduce sensory input.
The brain response to somatosensory input is abnormal in dystonia. This can be demonstrated with PET studies and evoked potential studies using EEG. In addition, studies of sensory receptive fields of neurons in the thalamus in humans with dystonia show expanded regions where cells all respond to the same passive movement. Mapping of the location of cortical sensory areas of the different fingers is abnormal in dystonia, and this is potentially consistent with the idea that there is abnormal cortical plasticity.
Lastly, there is some evidence that there might, in fact, be subtle abnormalities of sensation in patients with dystonia. The best evidence is for an abnormality of proprioception, the sense of movement of body parts.
How do doctors diagnose dystonia?
At this time, there is no test to confirm diagnosis of dystonia. Instead, the diagnosis of dystonia rests solely on the information from the affected individual and the physical and neurological examination. In order to correctly diagnose dystonia, therefore, doctors must be able to recognize the physical signs and be familiar with the symptoms. In certain instances, further tests may be ordered to be sure that there are not other problems associated with dystonia, but in many cases these tests will be normal.
When dystonia begins, often it may change significantly with different actions. For example, dystonia of the foot may occur when walking forward but disappear completely when walking backward or while sitting in a chair. In some people, dystonia involving the hand will only happen when writing and not with any other activity. The changeable nature of dystonia has led some physicians and even some dystonia-affected persons wondering if the cause of dystonia may be "all in their head." This is not true. Dystonia is a neurologic condition that is not the result of a psychiatric problem. In order to diagnose dystonia, a doctor who is familiar with the disorder is necessary.
If dystonia is diagnosed it is important to remember that features such as cognition, strength, and the senses, including vision and hearing, are normal.
Is a normal MRI typical analysis for the diagnosis of dystonia? Yes, unless the dystonia is the result of some other problem. If it's idiopathic dystonia, the MRI is normal. Blood tests are normal, and electrophysiology is, to a large degree, also normal. As far as secondary dystonia, it depends upon the reason for having it. Typically, if we do a large evaluation of someone with dystonia, that means we think there is something atypical about the way the person looks that says to us, "We'd better make sure that there is nothing else going on."
Can you die from dystonia?
In the overwhelming majority of people with dystonia, it does not shorten life expectancy or result in death. In very severe, generalized dystonia, affecting all body areas, there can be problems that may arise secondary to the dystonia which can cause medical illnesses. However, these instances are quite rare and usually treatable.
Dystonia has a variable nature, therefore making it difficult to predict the prognosis of the disorder. Currently, no medication or therapy can prevent progression from happening. The dystonia (both generalized and focal forms) will usually stabilize within five years of onset, but symptoms may fluctuate-for example, stressful situations may make symptoms temporarily worse. The following questions provide an overview of the prognosis and effects of dystonia. More specific information about the various forms of dystonia can be found on the Forms of Dystonia page.
My dystonic symptoms have been stable with no change for five years. Can I expect them to remain the same, or will they progress to becoming more debilitating?
Often dystonia will stabilize and not progress. In some patients with cervical dystonia, there may even be a remission. As a general rule, the older one is when dystonia develops, the more likely it will not progress beyond a certain point but will plateau. The younger one is when dystonia develops, the more likely that it will progress over time, particularly if the dystonia begins in a leg. And in such patients, the disorder can stabilize eventually and not progress any further. However, we always advise patients that they should not take dystonia for granted. There is no guarantee that the disease will not progress even though it has stabilized itself for a number of years. There is always a degree of uncertainty that something may develop and that the dystonia will start to flair up in the future and become worse again.
Can childhood dystonia go into remission and reappear as an adult?
Yes. But this happens quite rarely The figure used to be quoted that as many as 10% of patients (child and adult onset combined) might have such a spontaneous remission. It is probably much less than that. More frequently, instead of a true remission, the severity of dystonic postures may become much less for months or years in a small minority of patients. Nearly everyone has some degree of day-to-day fluctuation in the severity of his or her symptoms For a few, the fluctuation may be so much better and for such a long time that it seems like a remission. However, a careful exam will still reveal some involuntary postures. Those who do seem to have a true remission are likely to again have symptomatic dystonia sometime later.
What are the chances of a child with generalized dystonia, affecting mainly the feet and legs, developing other types of dystonia, like cervical dystonia?
When dystonia begins in childhood involving the legs and the feet, it is quite common for it to progress to involve the trunk, the arms, and even the neck. This is particularly true for early-onset generalized dystonia. In people with dopa-responsive dystonia, which also begins in the legs, the dystonia does not tend to become that severe in the upper body parts of the body.
Why do my symptoms improve at certain times of the day or during different seasons, and then become worse at other times?
It is fairly common for dopa-responsive dystonia to vary in severity during the course of a day. In these patients, dystonia may be absent when waking up in the morning or waking up after a nap and then worsening as the day progresses. Such diurnal variation is much less common in patients with idiopathic torsion dystonia, but some variation over long periods of time might develop. Dystonia, for example, tends to worsen with fatigue and after heavy exercise and tends to ameliorate with relaxation techniques. In most cases, dystonia tends to lessen and even disappear with deep sleep.
A child with generalized dystonia has progressed to a severe state. Medication is introduced and the child begins to respond and improve. What is the best that can be expected?
The medications that are currently available for treatment of generalized dystonia do not cure this disorder. It is likely that over time, the signs of generalized dystonia will progress as part of the disease itself. Therefore, if medicines start to work, there should be cautious optimism that they will continue to help the patient, but they will have to be chronically administered and cannot be expected to solve the patient's problem completely.
In addition to medications, focal injections of botulinum toxin may help abate dystonia in a particular area of the body; for instance, in generalized dystonia, where the neck muscles are profoundly in spasm, injections of botulinum toxin into the neck can give added benefit which is already being obtained with medications.
Finally, surgical intervention in the form of an operation known as a thalamotomy can relieve signs of dystonia. Generally, surgery is reserved for patients with a disability that is not adequately controlled by medications. Again, cure is not possible and moderate abatement of symptoms is the most for which we can presently hope. An example of a successful thalamotomy would be a patient who was formerly bed-ridden with severe spasms who now, after surgery, can stand and ambulate but still has significant dystonic spasms and voice problems.
Why do some patients have one dystonic symptom while others develop several?
Dystonia is highly variable in its manifestations, and this observation is one of the reasons that dystonia has been misunderstood for so long. Whereas one patient complains of painful cramps, another may find that the foot turns in unexpectedly during walking, but there is no pain or cramp at all. Scientists believe that the body area involved is determined by alteration in specific brain regions.
For example, in patients with dystonia on the left side of the body only, the chemical abnormality is thought to be predominantly or exclusively restricted to the right side of the brain. Further research is needed to determine exactly what portions of the brain relate to specific dystonic symptoms. One of the reasons that autopsy research is so important is the need to study individual symptoms and relate them to chemical and microscopic changes that occur in highly specific brain areas. Researchers hope that such efforts will lead to a clear understanding of the basis of dystonia and help scientists in their quest for treatment and cure.
Can dystonia cause difficulty swallowing or breathing?
Yes, sometimes. This depends primarily on the part(s) of the body affected. For instance, some people with dystonia involving the jaw or tongue may have chewing or swallowing difficulty. Occasionally, people with very severe cervical dystonia also may have some swallowing difficulty. Treatments, whether medications or botulinum toxin injections, can also potentially have swallowing side effects. Dystonia rarely affects breathing. Severe generalized dystonia may involve the diaphragm muscles (the primary breathing muscles) or cause enough truncal twisting to cause some problems with regular breathing.
After years of having dystonia, is the skeletal system affected in any way?
It may be, but not directly. Dystonia does not have a primary effect on bones. However, because of the abnormal postures that result from dystonic spasms, unusual mechanical stress may be placed on bones. For instance, if someone has a severe dystonia that involves a very sustained posture in one position, he/she may get a shortening of the ligaments and tendons so that the joint becomes "contracted" and can no longer move freely through a full range of motion. With time, this might be expected to cause excessive wear on the affected bones. Even short of a contracture, some bones may experience excessive wear because of such abnormal mechanical stresses. Bone changes, however, are not usually symptomatically important to people with dystonia. It is more often the case that we are concerned about the effect on muscles and related supportive tissues as they influence posture.
Does dystonia cause nervousness?
No, not directly. Dystonia can cause varying amounts of disability. People's reactions to their disability vary widely and can include different degrees of anxiety or depression.
When anxiety or depression are present enough to be clinically important, they can worsen the symptoms of dystonia. However, they do not worsen the underlying dystonia process. When anxiety or depression are prominent, they should be treated specifically as a separate problem with the usual options of treatment for those disorders.
Are there mood swings associated with dystonia?
There appear to be no particular mood problems associated directly with dystonia. However, sometimes the physical problems that occur with dystonia may lead to frustration and anxiety. Because dystonia tends to be a long-term disorder, this may lead to depression. Just as the symptoms of dystonia may vary from day to day, with "good" days and "bad" days, so may inner personal feelings. If emotional problems are prolonged, with feelings of sadness, hopelessness, and frustration, then advice should be sought from the doctor, and perhaps psychological counseling or suggested medications prescribed.
Is there anything helpful that can be done to ease my dystonia in a stressful situation?
Although clearly stress does not cause dystonia, many people with dystonia have reported that in a stressful situation, their symptoms worsen. This worsening is temporary and resolves when the stressful situation has passed. Unfortunately, getting rid of all stress in life is not possible. Therefore, techniques which result in a lessening of the stressful feelings may be beneficial. Relaxation techniques can be of considerable help. Although there are medications which can decrease anxiety, the effects of stress are best managed without additional medications. Health-care professionals familiar with the techniques of stress reduction may be very helpful.
Why do the muscle contractions of dystonia stop during sleep?
The theory is that the origin of the problem comes from the basal ganglia, which is above the brain stem. In the brain stem there is a system called the reticular-activating system, which is important in sleep. Sleep seems to cut off all the impulses from the brain in the motor pathway so that all the muscles relax. And this result supports the theory that dystonia originates from above the brain stem.
Is there a correlation between dystonia and fatigue?
The constant movement of dystonia can be compared to working out 18 hours a day-and for people whose symptoms don't stop during sleep, 24 hours a day. This can definitely result in fatigue and diminished stamina and make it more difficult to get through the day. Fatigue may be confused with lack of energy or motivation which may be a sign of depression or other medical conditions
What's the best way to deal with pain?
Pain is difficult to treat if symptoms don't respond to oral medications or botulinum toxin injections-often by relieving dystonia contractions and spasms, you can relieve the pain caused by these symptoms. Botulinum toxin injection can be quite effective in this regard. Muscle relaxants may have the same effect.
Over-the-counter pain medications (i.e. acetaminophen, ibuprofen, naproxen) should be tried first.
Physicians should ascertain whether the pain is due to the dystonia or to other secondary conditions such as arthritis or a compressed nerve.
If it comes from degeneration of the neck spine or impingement and irritation of nerve roots, that pain is very difficult to get rid of. Frequently, patients with neck dystonia report a lot of headaches. The pain goes from the back of the head to the occipital region and it can go all the way to the front. That kind of headache can sometimes be relieved by botulinum toxin injections, but some of the stronger analgesics are sometimes needed.
What can be done to alleviate the pain in the hip area?
Dystonia, most of the time, is not associated with pain, except for cervical dystonia in which neck pain tends to be fairly common. When it comes to having joint pain, it may be that a joint developed arthritis from all of the actions of the dystonia working on that joint.
Hip pain, thus, could be due to an arthritic condition. This needs to be checked out by a physician; and, if it is due to arthritis, the arthritis should be treated. If pain is due to muscle spasms, then there would a need to try to eliminate the spasms with medication or injections of botulinum toxin.
How would you treat dystonia and depression?
There are two major classes of medications for dystonia. The first type of medication, called anticholinergics, affect acetylcholine which can result in both improved symptoms and improved mood.
Depression can aggravate dystonia symptoms and make them worse. If a person is affected by both depression and dystonia, treating the depression often results in an improvement in the dystonia. Drugs called selective serotonin re-uptake inhibitors affect the levels of serotonin in the brain, thereby affecting a person's mood. There are so many anti-depressants available that treatment can be highly personalized to fit the needs of the patient-family history alone is no longer a basis for prescribing depression medication.
Treatment for dystonia is designed to help lessen the symptoms of spasms, pain, and disturbed postures and functions. Most therapies are symptomatic, attempting to cover up or release the dystonic spasms. No single strategy will be appropriate for every case.
The goal of any treatment is to achieve the greatest benefits while incurring the fewest risks. It is to allow you to lead a fuller, more productive life by reducing the effects of dystonia. Establishing a satisfactory regimen requires patience on the part of both the affected individual and the physician.
The approach for treatment of dystonia is usually three-tiered: oral medications, botulinum toxin injections, and surgery. These therapies may be used in alone or in combination.
Complementary care, such as physical therapy and speech therapy, may also have a role in the treatment management depending on the form of dystonia. For many people, supportive therapy provides an important adjunct to medical treatments.
Although there is currently no known cure for dystonia, we are gaining a better understanding of dystonia through research and are developing new approaches to treatments.
Medication treatments may lessen the symptoms of pain, spasm, and abnormal posturing and function. These treatments have differing mechanisms of action, so benefits and side-effects may be difficult to predict. One drug may work for one patient and not for another. Sometimes the benefit is only short-lived. The treatment of dystonia must be tailored to the individual patient.
There are several possible categories of medications used in the treatment of dystonia:
Anticholinergics
Anticholinergics include such drugs as Artane (trihexyphenidyl), Cogentin (benztropine), or Parsitan (ethopropazine) which block the acetylcholine. In most people the dosage is limited by central side effects such as confusion, drowsiness, hallucination, personality change, and memory difficulties, and peripheral side effects such as dry mouth, blurred vision, urinary retention, and constipation.
Benzodiazepines
Benzodiazepines, such as Valium (diazepam), Klonopin (clonazepam), and Ativan (lorazepam) block the Gaba-A receptor in the central nervous system. The primary side effect is sedation, but others include depression, personality change, and drug addiction. Rapid discontinuation can result in a withdrawal syndrome. Some dystonia patients may tolerate very high doses without apparent adverse effects.
Baclofen
Baclofen (Lioresal) stimulates the Gaba-B receptor. Intrathecal (spinal infusion) forms of Baclofen are also available.
Dopamine
Some patients with primary dystonia respond to drugs which increases dopamine such as Sinemet (levodopa) or Parlodel (bromocriptine); however, many patients respond to agents which block or deplete dopamine, such as standard anti-psychotics like Clozaril (clozapine), Nitoman (tetrabenazine), or Reserpine.
Can you explain how you start a person on a new medication?
Generally, a person starts on a medication at a low dose and slowly increases them. It may take weeks to months to undergo an adequate trial of one medication. Drug trials require tremendous patience in deciding whether one medication will work or not.
It is important to stay in contact with your physician because of the risk of the side effects and to report on how the trial is going.
During a drug trial, you may have to wait at a certain dose level or slowly taper off to discontinuation depending on the severity of side effects. Remember there is no "magic level" which you must obtain. Some people will experience benefits at a relatively low dose without side effects while others will require higher dosages. This is the reason physicians slowly increase the medicine because should you have benefits at a level that is acceptable, then that will probably be your level.
Overall, medication benefits between 40-60% of the dystonia patients, but medications have dose limitations because of side effects. Some reasons for medication failure is the lack of benefit and the occurrence of side effects. Other reasons include inadequate trials, not all possible medications tried, too many medications at one time, rapid increase in dose, or abrupt discontinuation.
What are the effects of these drugs on longevity?
The medications that are used for dystonia do not shorten life expectancy and can be used, as far as we know, indefinitely. The side-effects may force us to reduce them, but the side-effects are reversible.
What can be done for patients with drug-induced dystonia? Can it be counteracted?
There are several types of dystonia that can be induced by drug. One type is called an acute dystonic reaction and manifests itself as a dystonic state resulting after a one-time exposure to a medication. The medications that are most likely to induce dystonic reactions are the so-called neuroleptic drugs which have as a common mode of action to block the effects of the neurotransmitter dopamine in the brain. These reactions are generally self-limited but can be quite frightening. Acute dystonia induced by anti-psychotic or anti-emetic agents may be relieved by intravenous Benadryl (diphenhydramine), anticholinergics, or benzodiazepines.
Another type of drug-induced dystonia is called tardive dystonia. Tardive dystonia is produced by the long-term ingestion of drugs such as neuroleptics. The more common type of tardive syndrome is tardive dyskinesia wherein the movements are generally quick movements without sustained postures. Tardive dystonia is similar where many of the movements involve sustained posturing. It is generally considered to be a severe form of tardive dyskinesia. Tardive dystonia, induced by anti-psychotics or anti-emetics may be treated by withdrawal or the offending agents or by anticholinergics, benzodiazepines, baclofen, or clozapine; however this condition may be relatively resistant to treatments.
Tardive dyskinesia and tardive dystonia are very difficult to treat. Once initiated, they can be life-long problems although it is possible that they may spontaneously remit. There are a variety of therapeutic programs that have been suggested to be useful for treatment of tardive dystonia and while some are clearly successful in some patients, there is no therapy that is so uniformly successful that it might be considered a standard of care. Patients who are affected by tardive dystonia need to work closely with their doctors to try to find a successful regimen.
What drugs can cause tardive dystonia?
Drugs belonging to a class called "dopamine receptor blocking agents," also referred to as "neuroleptics," can cause dystonia. The following is a list of such drugs that can cause dystonia (trade name listed in parenthesis): Acetohenazine (Tindal®), Amoxapine (Asendin), Chlorpromazine (Thorazine®), Fluphenazine (Permitil®, Prolixin®), Haloperidol (Haldol®). Loxapine (Loxitane®, Daxolin®), Mesoridazine (Serentil®), Metaclopramide (Reglan®), Molindone (Lindone®, Moban®), Perphanzine (Trilafrom® or Triavil®), Piperacetazine (Quide®), Prochlorperzine (Compazine®, Combid®), Promazine (Sparine®), Promethazine (Phenagran®), Thiethylperazine (Torecan®), Thioridazine (Mellaril®), Thiothixene (Navane®),Trifluoperazine (Stelazine®), Triflupromazine (Vesprin®), and Trimeprazine (Temaril®).
Is Thorazine (chlorpromazine) a cause of or treatment for dystonia?
Thorazine is a dopamine receptor blocker. Many forms of dystonia (especially dopa-responsive dystonia) are associated with the role of dopamine in the brain. By blocking dopamine, Thorazine is capable of causing tardive (i.e. drug-induced) dystonia. In some instances dopamine blockers may help dystonia. It is generally best for people with dystonia to avoid medications that block dopamine receptors.
Are some drugs better suited to treat secondary rather than primary dystonia? Wilson's disease requires a very specific treatment; therefore in a case of secondary dystonia caused by Wilson's disease (which is a copper abnormality), the dystonia will be alleviated by treating the Wilson's disease. Tetrabenazine, a dopamine depleter, may be appropriate to treat tardive dystonia. For the most part, many of the drugs of choice for secondary dystonia also work well for primary dystonia and vice versa.
Can Artane (trihexyphenidyl), and/or Klonopin (clonazepam) be used during pregnancy?
They are not recommended. Treatment for dystonia during pregnancy is very individual. In some cases doses can be reduced; in other cases the woman may (gradually) stop taking oral drugs completely. There is no single recommendation for all women patients.