[Use of central anticholinergics in 2022]

Cholinergic antagonists have been used for 60 years in the treatment of movement disorders. Their effect arises from a modulating activity within basal ganglia motor circuitry. Due to diffuse distribution among many organs, anticholinergic medications have numerous adverse effects. Nowadays, the indication of these molecules in the treatment of Parkinson disease is reduced, due to more effective and better tolerated alternatives. Iatrogenic parkinsonism is hardly alleviated by anticholinergics. These medications allow to prevent acute dystonic reactions induced by highly-dosed first generation antipsychotic agents. Once acute dystonia has appeared, parenteral treatment is to be preferred, but oral cholinergic antagonists may be used after the acute phase to prevent relapse. Botulinum toxin is preferred to anticholinergics for focal dystonia. In generalized dystonia, anticholinergic moderately alleviate symptoms.