Review
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. May 19, 2024; 14(5): 624-634
Published online May 19, 2024. doi: 10.5498/wjp.v14.i5.624
Neurosurgical and pharmacological management of dystonia
Ali Ahmed Mohamed, Steven Faragalla, Asad Khan, Garrett Flynn, Gersham Rainone, Phillip Mitchell Johansen, Brandon Lucke-Wold
Ali Ahmed Mohamed, Steven Faragalla, Asad Khan, Garrett Flynn, Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, United States
Gersham Rainone, Phillip Mitchell Johansen, Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL 33606, United States
Brandon Lucke-Wold, Department of Neurosurgery, University of Florida, Gainesville, FL 32611, United States
Author contributions: Mohamed AA contributed to conceptualization; Mohamed AA and Lucke-Wold B contributed to methodology, validation, visualization, supervision, and project administration; Mohamed AA, Faragalla S, Khan A, Flynn G, Rainone G, and Johansen PM contributed to investigation; Mohamed AA, Faragalla S, Khan A, Flynn G, Rainone G, Johansen PM, and Lucke-Wold B contributed to write original draft preparation, review, and edit; and all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict-of-interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Brandon Lucke-Wold, MD, PhD, Neurosurgeon, Department of Neurosurgery, University of Florida, 1505 SW Archer Road, Gainesville, FL 32611, United States. brandon.lucke-wold@neurosurgery.ufl.edu
Received: February 4, 2024
Revised: April 20, 2024
Accepted: April 26, 2024
Published online: May 19, 2024
Processing time: 102 Days and 4.7 Hours
Abstract

Dystonia characterizes a group of neurological movement disorders characterized by abnormal muscle movements, often with repetitive or sustained contraction resulting in abnormal posturing. Different types of dystonia present based on the affected body regions and play a prominent role in determining the potential efficacy of a given intervention. For most patients afflicted with these disorders, an exact cause is rarely identified, so treatment mainly focuses on symptomatic alleviation. Pharmacological agents, such as oral anticholinergic administration and botulinum toxin injection, play a major role in the initial treatment of patients. In more severe and/or refractory cases, focal areas for neurosurgical intervention are identified and targeted to improve quality of life. Deep brain stimulation (DBS) targets these anatomical locations to minimize dystonia symptoms. Surgical ablation procedures and peripheral denervation surgeries also offer potential treatment to patients who do not respond to DBS. These management options grant providers and patients the ability to weigh the benefits and risks for each individual patient profile. This review article explores these pharmacological and neurosurgical management modalities for dystonia, providing a comprehensive assessment of each of their benefits and shortcomings.

Keywords: Botulinum toxin; Magnetic resonance imaging-guided focused ultrasound; Surgical ablation; Deep brain stimulation; Peripheral denervation surgery; Antipsychotics

Core Tip: Dystonia is a neurological movement disorder affecting different regions of the body with variable responses to current interventions. Pharmacological agents, such as oral anticholinergic and botulinum toxin injection, play a major role in the initial treatment of patients. However severe and/or refractory cases require the identification and targeting of focal areas for neurosurgical intervention. Deep brain stimulation (DBS) targets these anatomical locations to manage symptoms. Surgical ablation procedures and peripheral denervation surgeries also offer potential treatment to patients who do not respond to DBS.