Dystonia cannot be cured, but it can be treated! Significant progress has been made in recent years in the management of this pathology in order to best alleviate or even eliminate the spasms and their consequences on the daily lives of patients.
Drug treatments
In the case of drug-induced dystonia, it is possible very quickly to find alternative treatments to psychoses or nausea while treating the residual effect of the previous treatment on the spasms.
For dopa-sensitive dystonia, spasms are greatly reduced by drugs that restore the level of dopamine in the brain.
Patients with focal or segmental dystonia are treated with local injections of botulinum toxin into the muscles involved in involuntary contractions.
Botulism toxin has the effect of locally decreasing muscle contraction without affecting nerve transmission. For optimal effectiveness, injections must be repeated regularly (a few months). In some cases, kinesiotherapy may enhance the beneficial effect of botulism toxin injections.
For generalized dystonia, treatment is based on anticholinergic drugs. These molecules reduce spasms by blocking messages sent from neurons to muscles. Because the side effects of these treatments can be severe for patients, an alternative therapy is to use a mild sedative in combination with a muscle relaxant (myorelaxant).
In some severe forms of dystonia, transcranial magnetic stimulation or deep brain stimulation (DBS) may be necessary.
The therapeutic principle of these technologies is to send electrical or magnetic stimulation to affected brain regions in order to restore their function. Deep brain stimulation involves implanting an electrode into the patient's brain to electrically stimulate specific areas at depth.
Transcranial, non-invasive magnetic stimulation involves applying a magnetic field to the surface of the skull to modulate the activity of more superficial structures such as the cortex or cerebellum.
In very rare cases removal of the globus pallidus (cerebral region of the basal ganglia) by surgery may be indicated.
At Paris Brain Institute
The search for new therapeutic solutions and new targets for brain stimulation is at the heart of the research of the team of Marie Vidailhet and Stéphane Lehéricy, in connection with the reference centre at the Hospital de la Pitié-Salpêtrière AP-HP.
- A team coordinated by Professor Emmanuel Flamand-Roze of the Pitié-Salpêtrière hospital, AP-HP and researcher at Paris Brain Institute, tested the effectiveness of zonisamide, a drug used today to treat certain forms of epilepsy, in 23 patients with myoclonic dystonia.
- A study conducted by Zuzana Kozutska, winner of the Clinical Research Fellow of Paris Brain Institute, in the team of Marie Vidailhet and Stéphane Lehéricy, showed the long-term benefit (more than 10 years of follow-up) of deep brain stimulation in the internal globus pallidus, a structure of the basal ganglia, in a particular form of dystonia, the myoclonus dystonia, with an excellent improvement of motor functions and social adaptation. The teams of the Brain Institute, linked to the CENIR platform of the Neuroimaging Centre of Paris Brain Institute, are pioneers in the use and development of transcranial magnetic stimulation.