Early to Treatment, Early to Muscle Control

Dystonia patients recover quicker with brain stimulation therapy

(RxWiki News) Dystonia is an uncommon disorder that causes the muscles to contract when they should be relaxed, sometimes disabling patients for years. Starting treatment sooner rather than later leads to better results.

Researchers found that dystonia patients have a better recovery if they start deep brain stimulation therapy - a surgery that involves putting a pacemaker in the brain - earlier in the course of the disease. They also found that age has an effect on how quickly patients recover. That is, younger patients need less time to reach their best possible improvement.

dailyRx Insight: The sooner you start treatment for dystonia, the quicker and better your recovery will be.

Before this study, researchers already knew that younger patients who had dystonia for less time showed better short-term results than older patients with a longer disease duration. However, this new study shows that these younger patients also do better in the long term, says senior author Michele Tagliati, M.D., director of the Movement Disorders Program at Cedars-Sinai Medical and one of the world's top experts on deep brain stimulation therapy.

Tagliati adds that while older patients may not feel the speedy recovery of younger patients, their symptoms will improve over the course of a few years.

For their study, Tagliati and colleagues analyzed 44 dystonia patients between 10 and 59 years of age. The patients were divided into three categories:

  1. Those under 27 years of age who had dystonia for less than 17 years
  2. Those over 27 years of age who had dystonia for less than 17 years
  3. Those over 27 years of age who had dystonia for more than 17 years

The researchers assessed the condition of patients' dystonia at three points: right after treatment began, one year after treatment, and three years after treatment.

They found that all but three of the patients showed improvement after receiving the pacemaker implant - a device that sends electrical signals to certain parts of the brain. Even though five patients showed poorer results at three years, they continued to show overall improvement and did not return to their level of disability before treatment.

Before their surgery, 32 patients were taking prescription drugs for dystonia. After one year, this number decreased by 52 percent, and by 80 percent after three years.

It is estimated that as many as 300,000 people in the United States have dystonia, making it the third most common movement disorder, behind essential tremor and Parkinson's disease. Dystonia is a neurological problem that causes the muscles in the body to sustain prolonged contractions, causing abnormal postures and repetitive movements, along with pain, cramping, and muscle spasm. It can be primary (no known cause) or secondary (environmental or traumatic), and affects the body in general (generalized) or specific muscles and body parts (torticollis in the neck, blepharospasm of the eyelids). Diagnosis is made from patient history, as well as genetic tests, electromyography (EMG) and electroencephalography (EEG). Treatments include physical therapy and exercises, as well as anti-cholinergic medications (benztropine, diphenhydramine), muscle relaxants (clonazepam, Botox), and dopamine agonists (Sinemet, bromocriptine). Surgery is sometimes an option in extreme cases, by denervating the affected muscles. Patients may suffer some disability, but can expect to live a normal lifespan.

The study is published in the Journal of Neurology.

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Review Date: 
March 30, 2011