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Treatment of dystonia

Cynthia Comella, MD
Section Editor
Howard I Hurtig, MD
Deputy Editor
John F Dashe, MD, PhD


The treatment of dystonia is symptomatic. No curative therapies are available. Management options include oral medications, botulinum toxin injection, and deep brain stimulation.

This topic will review the treatment of dystonia. Other clinical aspects of dystonia are discussed separately. (See "Classification and evaluation of dystonia".)


Many oral agents have been used to treat dystonia, but they have not been extensively studied in rigorous controlled trials. The available evidence suggests that several drugs are beneficial in a proportion of patients with dystonia (table 1). However, the therapeutic window for most of the oral agents is narrow, and side effects frequently limit clinical benefit [1].

Levodopa — Levodopa is dramatically beneficial in dopa-responsive dystonia (DRD). Often, small doses of levodopa one to three times daily can virtually eliminate the dystonic symptoms of DRD for an indefinite period of time without causing motor complications [2-4]. A sustained and complete response occurs with variable doses ranging from 100 to 750 mg daily [2,5]. One case series of 20 patients reported that the mean daily levodopa doses for clinical benefit in patients with and without associated dyskinesia were 343 mg and 189 mg [4].

In other forms of dystonia, the response rate with levodopa is approximately 15 percent [6].

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Literature review current through: Sep 2017. | This topic last updated: Sep 22, 2017.
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