Introduction
The chapter concerning therapies aimed at treating dystonia is very articulated and, at the same time, delicate and thorny: unfortunately, Science has not yet identified a definitive and definitive cure for definitively eradicating the kinetic disorder. Each dystonic patient is unique, since the disease begins or progresses through different symptoms, sometimes stable over time, sometimes variable; consequently, the therapy must be personalized to the individual.
therapies
Considering that the chances of complete and definitive healing of dystonia are almost nil, the therapies aim above all at correcting spastic symptoms, reducing pain, assuming less incorrect postures and, above all, improving the patient's quality of life.
At the base of the therapeutic treatments, the etiological investigation: as already discussed, unfortunately, the search for causes is not always immediate and this is precisely what prevents us from finding the most suitable therapy; consequently, the improvement of the dystonic condition is slowed down and, in some cases, even prevented. In secondary forms, which consequently lead to particular diseases (stroke neoplasms, neuroleptic use for long periods, etc.), the patient responds more satisfactorily to therapies, precisely because the triggering cause is known. The only approach to primary dystonia remains symptomatic therapy, ie treatment based solely on symptoms.
Following the oral administration of specific pharmacological specialties, a positive response was observed in most juvenile generalized dystonic forms.
The following are the most commonly used treatment options:
- Oral administration of targeted pharmacological specialties
- Intrathecal administration of muscle relaxants
- Botulinum toxin injections : particularly useful for the treatment of focal forms of dystonia. Botulinum toxin is the drug of first choice not only for the treatment of dystonia, but also for all forms of dyskinesia. Not to forget that the botulinum toxin remains one of the most powerful and lethal poisons in nature: Clostridium botulinum can generate a progressive paralysis (flaccid paralysis), involving the mimic muscles, swallowing and breathing, thus inducing death. However, the power of the drum is also used in the medical field: the ability of the botulinum toxin to release the musculature is used, in order to resolve dystonia and, more generally, to cure serious hypokinetic and hyperkinetic disorders. The botulinum toxin is injected directly into the muscle involved by dystonia and the effect is almost rapid in most patients (positive results after 10 days).
- Surgical therapy : the only conceivable option for patients who do not respond to pharmacological treatment. For example, for the treatment of laryngeal dystonia, selective peripheral denervation is recommended, while for blepharospasm surgical myomectomy is preferred.
- Neurosurgery intervention : the target of the therapy is represented by the deep nuclei located near the brain. Neurosurgery involves the subcutaneous insertion of a particular electrode, directly connected to a pacemaker, located in the upper region of the chest.
- Non-pharmacological therapies : in general, these therapeutic options are recommended in conjunction with targeted pharmacological treatments. However, "non-pharmacological therapy" means a particular approach, based on physical therapies (physiotherapy) or verbal (logopedic), aimed at gaining greater patient awareness and self-control. Furthermore, physiotherapy sessions are useful for optimizing drug therapies, in particular those based on botulinum toxin injections.
- Psychological support therapy
- Casting of the limb : useful therapeutic option for treating the scamp of the scribe, the musician or for all occupational-type dystonia. The cast causes the immobility of the involved limb (eg hand-arm), therefore a hypothetical recovery of the disorder.
- Physical therapy : as can be guessed, physical therapy is not able to cure dystonia, since it is - the latter - a disorder that is mostly neurological. However, physical therapy is a valid option, useful for the patient to monitor and self-manage the secondary symptoms caused by dystonia. Clearly, physical therapy cannot replace the pharmacological one, but it is a benefit to complete it, therefore to improve the quality of life of the dystonic.
- Complementary therapy : this therapy is aimed at easing dystonic spastic symptoms, not at healing them. It is based on relaxation techniques (eg yoga, meditation, pilates, etc.), sometimes also associated with acupuncture, aimed at calming the pain.
Prognosis and conclusions
As analyzed, there is no definite and established cure for the various dystonic forms. The onset age of dystonia is fundamental to hypothesize an evolutionary prognosis of kinetic disorder: when dystonia arises at an early age, the probability of degeneration of the disease is unfortunately higher than in those patients in whom dystonia begins in adulthood. As a result, patients with dystonia during adulthood are more likely to have a positive prognosis. As far as focal dystonia is concerned, the prognosis is rarely not good, since this dystonic form, only rarely, tends to get worse.
Each dystonic individual is unique, since the symptoms associated with the disease, as well as the contractions and spasms, are not always the same in the sick; currently, Science does not have adequate equipment capable of providing a hypothetical prognosis for dystonia. Some forms of dystonia stabilize over the years, others get worse, others still seem to stabilize but in case of stress the symptoms worsen. In conclusion, there is still no definitive therapy, therefore the prognosis cannot be hypothesized; however, timely intervention can certainly reduce symptoms and ease pain, both physical and psychological, induced by dystonia.
