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[Use of central anticholinergics in 2022].
E Parmentier1, F Depierreux1, P Maquet1
1Service de Neurologie, CHU Liège, Belgique.
Cholinergic antagonists, used for 60 years to treat movement disorders, are less favored for Parkinson disease due to side effects and better alternatives. They remain useful for preventing antipsychotic-induced dystonia.
Area of Science:
- Neuroscience
- Pharmacology
Context:
- Cholinergic antagonists have a 60-year history in managing movement disorders.
- Their therapeutic effects stem from modulating basal ganglia motor circuitry.
- Widespread organ distribution leads to significant anticholinergic adverse effects.
Purpose:
- To review the role of cholinergic antagonists in movement disorder treatment.
- To discuss their efficacy and limitations, particularly in Parkinson disease and dystonia.
Summary:
- Cholinergic antagonists are less indicated for Parkinson disease due to newer, better-tolerated treatments.
- They are effective in preventing acute dystonic reactions from antipsychotics but less so for established or focal dystonia.
- Botulinum toxin is now preferred for focal dystonia, while anticholinergics offer moderate relief for generalized dystonia.
Impact:
- Highlights the declining role of anticholinergics in Parkinson disease management.
- Underscores their specific utility in preventing drug-induced dystonic reactions.
- Positions botulinum toxin as a superior option for focal dystonia.
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