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High Dose Anticholinergic Therapy in Adult Dystonia

Published online by Cambridge University Press:  18 September 2015

Anthony E. Lang
Anthony E. Lang*
Affiliation:
Movement Disorder Clinic, Toronto Western Hospital
*
Movement Disorder Clinic, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario, Canada M5T 2R2
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Abstract:

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Forty-four adult patients with various forms of dystonia were treated with anticholinergics slowly increased to maximum tolerated doses. Thirty-seven per cent of the 35 idiopathic dystonia patients had a moderate to marked improvement with an average dosage of 21.5 mg of trihexyphenidyl. Younger patients with a shorter duration of dystonia and those who tolerated higher doses tended to benefit most. However there were exceptions to all of these factors. None of the nine patients with symptomatic dystonias improved more than mildly and most had no benefit despite the use of dosages similar to those resulting in improvement in idiopathic dystonia patients. Side effects were common. These often forced drug withdrawal at lower doses than those which might have resulted in improvement. These results suggest that high dose anticholinergics should be the first line of therapy for disabling dystonia.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 13 , Issue 1 , February 1986 , pp. 42 - 46
Copyright
Copyright © Canadian Neurological Sciences Federation 1986

References

REFERENCES

1.Fahn, S.Treatment of dystonia with high-dosage anticholinergic medication. Neurology (NY) 1979; 29: 605.Google Scholar
2.Burke, RE, Fahn, S.Double-blind evaluation of trihexyphenidyl in dystonia. Adv Neurol 1983; 37: 189–192.Google ScholarPubMed
3.Fahn, S.High dosage anticholinergic therapy in dystonia. Neurology (Cleveland) 1983; 33: 1255–1261.CrossRefGoogle ScholarPubMed
4.Marsden, CD, Marion, M-H, Quinn, N.The treatment of severe dystonia in children and adults. J Neurol Neurosurg Psychiatry 1984; 47: 1166–1173.CrossRefGoogle ScholarPubMed
5.Lang, AE, Clarke, JTE, Resch, L, Strasberg, P, Skomorowski, MA, O'Connor P. Progressive longstanding “pure” dystonia - a new phenotype ofjuvenile metachromatic leukodystrophy. Neurology (Cleveland) 1985; 35 (suppl 1): 194.Google Scholar
6.Segawa, M, Hosaka, A, Miyagawa, F, Nomura, Y, Imai, H.Hereditary progressive dystonia with marked diurnal fluctuations. Adv Neurol 1976; 14: 215–233.Google Scholar
7.Sunohara, N, Mano, Y, Ando, K, Satoyoshi, E.Idiopathic dystoniaparkinsonism with marked diurnal fluctuation of symptoms. Ann Neurol 1985; 17: 39–45.CrossRefGoogle ScholarPubMed
8.Lang, AE, Sheehy, MP, Marsden, CD.Anticholinergics in adultonset focal dystonia. Can J Neurol Sci 1982; 9: 313–319.CrossRefGoogle ScholarPubMed
9.Marsden, CD, Lang, AE, Sheehy, MP.Pharmacology of cranial dystonia. Neurology (NY) 1983; 33: 1100–1101.CrossRefGoogle ScholarPubMed
10.Lang, AE, Marsden, CD.Alphamethylparatyrosine and tetrabenazine in movement disorders. Clin Neuropharmacol 1982; 5:375–387.CrossRefGoogle Scholar
11.Duvoisin, RC.Meige syndrome: relief on high-dose anticholinergic therapy. Clin Neuropharmacol 1983; 6: 63–66.CrossRefGoogle ScholarPubMed
12.Lai, S, Hoyte, K, Kiely, ME, Sourkes, TL, Baxter, DW, Missala, K, Anderman, F.Neuropharmacological investigation and treatment of spasmodic torticollis. Adv Neurol 1979; 24: 335–351.Google Scholar
13.Tanner, CM, Glantz, RH, Klawans, HL.Meige disease: acute and chronic cholinergic effects. Neurology (NY) 1982; 32: 783–785.CrossRefGoogle ScholarPubMed
14.Tanner, CM, Goetz, CS, Weiner, WJ, Nausieda, PA, Wilson, R, Klawans, HL.The role of cholinergic mechanisms in spasmodic torticollis. Neurology (NY) 1979; 29: 604–605.Google Scholar
15.Marsden, CD, Obeso, JA, Zarranz, JJ, Lang, AE.The anatomical basis of symptomatic dystonia. Brain 1985; 108: 463–483.CrossRefGoogle Scholar
16.Maltese, WA, Bressman, S, Fahn, S, De Vivo, DC.Acetylcholinesterase activity in patients with torsion dystonia. Arch Neurol 1985; 42: 154–155.CrossRefGoogle ScholarPubMed
17.Marsden, CD.Treatment of torsion dystonia. In: Barbeau, A, ed. Disorders of Movement. Lancaster: MPT Press 1981: 81–104.Google Scholar
18.Nutt, JG, Hammerstad, JP, de Garma, P, Carter, J.Cranial dystonia: double-blind crossover study of anticholinergics. Neurology (Cleveland) 1984; 34: 215–217.CrossRefGoogle ScholarPubMed