A Cervical Dystonia Successfully Treated with Tetrabenazine Augmentation of Clozapine and Botox.

Abstract

Introduction

Tetrabenazine is a presynaptic depleter of dopamine, a monoamine storage inhibitor that was first introduced in the 1970s for the management of hyperkinetic movement disorders and which reduces the muscle spasms without systemic side effects, and is also used in patients with generalized or multifocal dystonia [1,2,3]. The aim of this study is to present a case report of a patient treated with tetrabenazine augmentation of clozapine and botox.

Method

SC, a 44-year-old Caucasian gentleman affected by paranoid schizophrenia, had developed chronic extrapyramidal side effects (dystonia and spazmatic torcicollis), due to the continuos treatment with classical neuroleptics. He received botox inijections and antipsychotic treatment (clozapine 400 mg/day). We then prescribed tetrabenazine progressively increased up to 75 mg/day, with a progressive reduction of the spazmatic torcicollis in the subsequent 3-6 months.

Results

A case report with a positive response to the treatment with tetrabenazine augmentation of clozapine and botox.

Discussion and conclusion

To our knowledge, this is the first paper reporting an improvement of a dystonia (spazmatic torcicollis) with tetrabenazine augmentation of clozapine and botox treatment. The particular mechanism of action of tetrabenazine could provide an innovative treatment of this negative, adverse and chronic event, with consequent improvement of the quality of life of the patients suffering from it. Further research is warranted to replicate our clinical observations and, in general terms, controlled studies are needed to confirm the efficacy of this treatment.