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Paramedical treatment in primary dystonia: A systematic review

Authors

  • Cathérine C.S. Delnooz MD,

    1. Department of Neurology, Donders Centre for Neuroscience, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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  • Martin W.I.M. Horstink MD, PhD,

    1. Department of Neurology, Donders Centre for Neuroscience, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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  • Marina A. Tijssen MD, PhD,

    1. Department of Neurology, Amsterdam Medical Centre, Amsterdam, The Netherlands
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  • Bart P.C. van de Warrenburg MD, PhD

    Corresponding author
    1. Department of Neurology, Donders Centre for Neuroscience, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
    • Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Centre for Neuroscience, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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  • Potential conflict of interest: None reported.

Abstract

Dystonia is a disabling movement disorder with a significant impact on quality of life. The current therapeutic armamentarium includes various drugs, botulinum toxin injections, and occasionally (neuro)surgery. In addition, many patients are referred for paramedical (including allied health care) interventions. An enormous variation in the paramedical treatment is provided, largely because evidence-based, accepted treatment regimes are not available. We have conducted a systematic review of studies that explored the effect of various paramedical interventions in primary dystonia. Only studies that have used clinical outcome measures were included. There were no class A1 or A2 studies and therefore, level 1 or 2 practice recommendations for a specific intervention could not be deducted. Many papers were case reports, mostly with a very limited number of patients and a clear publication bias for beneficial effects of a particular paramedical intervention. Some potentially interesting interventions come from class B studies, which include physical therapy in addition to botulinum toxin injections (BoNT-A) in cervical dystonia; sensorimotor training and transcutaneous electrical nerve stimulation (TENS) in writer's cramp; and speech therapy added to BoNT-A injections in laryngeal dystonia. Good quality clinical studies are therefore warranted, which should have the aim to be generally applicable. A design in which the paramedical intervention is added to a current gold standard, for example, BoNT-A injections in cervical dystonia, is recommended. © 2009 Movement Disorder Society

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