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Anticholinergics in Adult-Onset Focal Dystonia

Published online by Cambridge University Press:  18 September 2015

Anthony E. Lang ,
Michael P. Sheehy  and
C. David Marsden
Anthony E. Lang*
Affiliation:
University Department of Neurology, Institute of Psychiatry, de Crespigny Park, Denmark Hill, London SE5,8AF, U.K
Michael P. Sheehy
Affiliation:
University Department of Neurology, Institute of Psychiatry, de Crespigny Park, Denmark Hill, London SE5,8AF, U.K
C. David Marsden
Affiliation:
University Department of Neurology, Institute of Psychiatry, de Crespigny Park, Denmark Hill, London SE5,8AF, U.K
*
Division of Neurology, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario, Canada
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Anticholinergics are one of the most common treatments used in adult-onset focal dystonias although their general efficacy has not been proven. We have investigated the effects of intravenous administration of atropine, benztropine and chlorpheniramine, in comparison to normal saline, in 20 patients with adult-onset focal dystonias (spasmodic torticollis (9), cranial dystonia (6), writer’s cramp (5)), and have retrospectively reviewed the notes of 78 patients (spasmodic torticollis (38), cranial dystonia (25), writer’s cramp (15)), who had received chronic oral anticholinergic therapy in varying doses at some time in the past. Patients with spasmodic torticollis and writer’s cramp showed no consistent change with any of the intravenous drugs, while the few with cranial dystonia who improved usually did so at the expense of drug-induced sedation. The natural variability of these disorders was evident in the response to normal saline, which caused changes in the scores for severity of the involuntary movements of 20% or more in some patients. Only 8 of the patients who had received chronic oral therapy obtained more than mild benefit, and in 3 of them this improvement was transient. We conclude that cholinergic mechanisms are not of general or prime importance in the pathogenesis of adult-onset focal dystonias. However, each new patient warrants a trial of chronic oral anticholinergic therapy in view of the occasional useful responses obtained with these drugs.

Type
Hypothesis
Information
Canadian Journal of Neurological Sciences , Volume 9 , Issue 3 , August 1982 , pp. 313 - 319
Copyright
Copyright © Canadian Neurological Sciences Federation 1982

References

Altrocchi, P.H. (1972) Spontaneous oral-facial dyskinesia. Arch. Neurol. 26: 506–512.CrossRefGoogle ScholarPubMed
Burke, R.E., Fahn, S., Jankovic, J., Marsden, C.D., Lang, A.E., Gollomp, S., Ilson, J. (1982) Tardive Dystonia: Late-onset and persistent dystonia caused by neuroleptic drugs. Neurology (Ny) (in press).CrossRefGoogle Scholar
Casey, D.E. (1980) Pharmacology of blepharospasm – oromandibular dystonia syndrome. Neurology, 30: 690–695.CrossRefGoogle ScholarPubMed
Coyle, J.T. and Snyder, S.H. (1969) Antiparkinsonian drugs: inhibition of dopamine uptake in the corpus striatum as a possible mechanism of action. Science 166: 899–901.CrossRefGoogle ScholarPubMed
Fahn, S. (1982) High dosage anticholinergic therapy in dystonia. Adv. Neurol, (in press) Raven Press, New York.Google Scholar
Fuxe, K., Goldstein, M. and Ljungdahl, A. (1970) Antiparkinsonian drugs and central dopamine neurones. Life Sci. 9 pt 1:811–824.CrossRefGoogle Scholar
Gollomp, S., Fahn, S., Burke, R.E., Reches, A., Ilson, J. (1982) Therapeutic trials in Meige Syndrome. Adv. Neurol, (in press) Raven Press, New York.Google Scholar
Lal, S., Hoyte, K., Kiely, M.E., Sourkes, T.L., Baxter, D.W., Missala, K. and Anderman, F. (1979) Neuropharmacological investigation and treatment of spasmodic torticollis. In: Adv. Neurol. 24, Eds. Poirier, L.J., Sourkes, T.L. and Bedard, P.J.. 335–351, Raven Press, New York.Google Scholar
Lal, S., Young, S.N., Kiely, M.E., Hoyte, K., Baxter, D.W., Sourkes, T.L. (1981) Effect of L-Tryptophan on Spasmodic Torticollis. Can. J. Neurol. Sci. 8:305–308.CrossRefGoogle ScholarPubMed
Marsden, C.D. (1976) Blepharospasmoromandibular dystonia syndrome (Brueghel’s syndrome). A variant of adult-onset torsion dystonia? J. Neurol. Neurosurg. Psychiatry. 39: 1204–1209.CrossRefGoogle ScholarPubMed
Marsden, C.D. (1976a) The problem of adult-onset idiopathic torsion dystonia and other isolated dyskinesias in adult life. Adv. Neurol. 14, Ed. Eldridge, R. and Fahn, S.. 259–276, Raven Press, New York.Google Scholar
Marsden, C.D. and Schachter, M. (1981) Assessment of extrapyramidal disorders. Br. J. Clin. Pharmac. 11: 129–151.CrossRefGoogle ScholarPubMed
Marsden, C.D., Tarsy, D., Baldessarini, R.J. (1975) Spontaneous and drug-induced movement disorders in psychotic patients. In: Psychiatry Aspects of Neurological Disease. Ed. Benson, F.D. and Blumer, D.219–266, Gune and Stratton, New York.Google Scholar
Meldrum, B.S., Anlezark, G.M. and Marsden, C.D. (1977) Acute dystonia as an idiosyncratic response to neuroleptics in baboons. Brain 100: 313–326.CrossRefGoogle ScholarPubMed
Nutt, J.G., Hammerstad, J.P., Carter, J.H., Degarmo, P.L. (1982) Treatment of Meige’s syndrome with Artane. Adv. Neurol, (in press), Raven Press, New York.Google Scholar
Tanner, C.M., Glantz, R.H., Klawans, H.L. (1981) Meige Syndrome (Blepharospasm/oromandibular dystonia syndrome): Analysis of the clinical pharmacology in 12 patients. Neurology 31: 78.Google Scholar
Tanner, C.M., Goetz, C.G. and Klawans, H.L. (1979) Cholinergic mechanisms in movement disorders: results of physostigmine and scopolamine administration. In: Nutrition and the Brain, vol. 5, Ed. Barbeau, A., Growdon, J.H. and Wurtman, R.J., 273–284, Raven Press, New York.Google Scholar
Tanner, C.M., Goetz, C.G., Weiner, W.J., Nausieda, P.A., Wilson, R. and Klawans, H.L. (1979a) The role of cholinergic mechanisms in spasmodic torticollis. Neurology 29, 604–605.Google Scholar
Tolosa, E.S. and Lai, C. (1979) Meige disease: striatal dopaminergic preponderance. Neurology 29: 1126–1130.CrossRefGoogle ScholarPubMed
Zeeman, W. (1970) Pathology of the torsion dystonias (dystonia musculorum deformans) Neurology 20: Pt 2: 79–88.CrossRefGoogle Scholar