Toxins
A number of uncommon toxins are capable of causing brain damage centered in the
motor control region known as the
basal ganglia. Dystonia may be one prominent
feature experienced by people with these exposures, but it is extremely
uncommon for "pure dystonia" to be seen in such patients. In other
words, the vast majority of people exposed to toxins (for example, manganese,
cyanide, 3-nitropropionicacid) have additional neurological problems associated
with the dystonia. Possibly the most common feature in such patients is the
presence of parkinsonism.
DiagnosisMany of the ascribed causes of secondary dystonia are based
on historical information or subtle characteristics of the symptoms, and have
no diagnostic, radiologic, serologic, or other pathologic trademark.
TreatmentOral medications are often
the mainstay of treatment for
secondary dystonia. Although there is no single
drug that helps an overwhelming number of individuals, there are several that
may be of benefit. These oral medications include levodopa, trihexyphenidyl,
clonazepam, and baclofen (oral and
intrathecal—especially for dystonia and
spasticity). Medications may be taken in combination.
Botulinum toxin injections
may be used to treat specific body parts that may be affected, such as the
neck, jaw, hands, or feet.
Several surgical techniques
may be appropriate for
select individuals who do not respond to medications and botulinum toxin
injections. These include ablative surgeries such as
pallidotomy and
thalamotomy,
intrathecal baclofen, and
deep brain stimulation.
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