[Treatment of dystonias]

SYMPTOMATIC TREATMENT: Treatment of idiopathic dystonia depends on the age of onset and the extent of the disease. Symptomatic treatment has made many advances over the last 20 years.

In childhood onset cases, it is important first to exclude dopa-responsive dystonia. Most of these patients will respond subsequently to high dose anticholinergics.

Treatment of this form has been transformed by botulinum toxin therapy.

The treatment of each focal dystonia (blepharospasm, spasmodic torticollis, oromandibular dystonia, laryngeal dystonia, writer's cramp, foot dystonia and axial dystonia) are reviewed. Treatments must be titrated carefully. Botulinum toxin injections require precision and must be repeated regularly. A rehabilitation program must be adapted to each individual. Surgery, in very severe cases, requires an extensive well-planned discussion of indications.