[The dystonias--botulinum toxin, deep brain stimulation, pharmacotherapy, motor training]

Abstract

Despite great advances in the understanding of the dystonias, treatment for most patients remains symptomatic. Botulinum neurotoxin (BoNT) is the treatment of choice for focal dystonias. Selected issues related to the use of BoNT are highlighted with pertinent illustrations. In certain focal, mainly in generalised dystonias BoNT may not be sufficient or appropriate. Besides BoNT pharmacotherapy, nowadays increasingly deep brain stimulation, psychotherapy, physio- and occupational therapy approaches can be included in the management of dystonic patients. The review focuses on experiences with established management guidelines and new developments in the treatment of dystonias.