It's a mistake to shrug
your shoulders over patients with severe generalized dystonia, says
neurologist "Buz" Jinnah. "Or with any dystonia. We can do
something for everyone. It's just a matter of degree." Jinnah offers oral
drugs like artane, which directly squelch neurotransmission to muscles, or
benzodiazepines, well known as overall muscle relaxants.
Fred Lenz (center) confers on the best brain approach to halt dystonia.
Patients with focal dystonias such as torticollis (head and neck)
or blepharospasm (eyelid) respond "wonderfully" to botulinum toxin, he
says. And botox can help generalized patients as well, as can a drug-
containing pump surgically implanted beneath the skin. The pump typically
bathes the spinal cord in the muscle relaxant baclofen.
For
torticollis patients who don't respond to botox or medication, selective
nerve sectioning can be very effective, says neurosurgeon Fred Lenz,
M.D., who has done many such operations. And a reversible procedure,
deep brain stimulation (DBS), has recently won FDA approval for primary
generalized dystonia that's otherwise unresponsive. DBS involves easing a
fine stimulating electrode into the brain's globus pallidus. "Stimulating
that particular area made sense," Lenz says, "after we saw the relief
Parkinson's patients with dystonia experienced following DBS for
parkinsonian tremor." Lenz has performed 20 of the surgeries for dystonia.
Patients who are helped, he says, have a dramatic turnaround.
