There are also many effective drugs that are commonly used for dystonia, mainly drugs that affect the neurotransmitter chemicals. These are broken up into a few main groups:

• Anticholinergics- Which block a neurotransmitter called acetylcholine which allows nerve cells and muscles to communicate.
• Benzodiazepines- Which affect the nervous systems ability to process a neurotransmitter called GABA-A. They are generally known to cause mild to severe sedation, while in some cases dystonia patients can handle very large amounts with little to no adverse effects.
• Baclofen- Actually a drug, not a category of drugs, it stimulates the body’s ability to process a neurotransmitter called GABA-B. It is not uncommon to see intrathecal forms, where a surgically implanted device keeps a steady dose of Baclofen fed into the nervous system.
• Dopaminergic agents/Dopamine-depleting agents- Sometimes patients with primary dystonia respond well to drugs that increase the neurotransmitter dopamine in the brain, however other patients respond well to drugs that decrease the amount of dopamine. Like almost all other aspects of dystonia it is very specific to the person, and treatments that work in some patients just won’t work in others.
• Tetrabenezine is another drug that reduces dopamine and may help some patients, although it is not generally available in the US.
• Botox injections are commonly thought of as a cosmetic treatment, commonly used to reduce facial lines that come with age. However it was originally developed to treat eye muscle spasms, dystonia, and other muscle spasm problems. Botulinium toxin is the most toxic substance known to man, but used in very small doses it can help muscle spasms. It is produced from a bacteria called Clostridium botulinium, which actually has 7 different distinct serological types. Type A and B have both been approved by the FDA for specific medical treatments, with A being the strongest and most widely used. Medically speaking, the action the Botox performs is called muscle denervation, basically it keeps the muscle and nerves from communicating. This happens by blocking acetylcholine receptors in the muscle for an average of 3-5 months. Acetylcholine is the chemical released from the nerve side of the junction where nerve and muscle meet that starts a chemical reaction that tells muscles to move. So when the acetylcholine is released, it has no receptors to bind to, and the muscle has no idea it’s supposed to move.
• Deep brain stimulation is another good option with great results being documented, but it is generally reserved until after medication proves to not work, and Botox isn’t helping as much. It is a surgical treatment where a medical device called a “brain pacemaker” is implanted into the globus pallidus or the subthalamic nucleus in dystonia cases. It is connected to pulse generator located in the chest which can be fine tuned by a neurologist, or other trained specialist to control any side effects and adjust to the patient’s needs. The lead is the part implanted in the brain, it is made of coiled wire coated in polyurethane with four platinum iridium electrodes. The lead is connected to the IPG (Internal Pulse Generator) by the extension which runs down the head, behind the ear, through the neck, and down to the chest. The implantation surgery is performed under general anesthesia, with a hole drilled into the skull which is about 14 mm in diameter. While DBS is proven to be very effective, there are some potential complications and/or side effects. But this is commonly due to the placement of the electrodes in the brain, and therefore can be fine tuned by the neurologist according to patient feedback, so is generally reversible. Almost all patients report an improvement in the quality of living after DBS surgery.
• If none of the other treatments help, or if your doctor strongly recommends it lesioning procedures are sometimes used, which is the targeted destruction of certain abnormal brain tissue. Dystonia is shown to generally originate from the part of the brain called the basal ganglia, which contains the globus pallidus, the thalamus, and the subthalamic nucleus. All of them targets of dystonia surgery, only in lesioning procedures the globus pallidus and/or the thalamus are the targeted areas. While it can be a dangerous surgery, as any brain surgery can be, brain surgery for dystonia has resulted in marked improvements in many patients. The brain sends messages to different parts of the body through pathways and circuits in the brain, and in patients with dystonia these pathways are disrupted. These pathways are what the surgeon targets and tries to clear up so that the patient can receive the chemical and electrical messages sent through the brain.

Because of the limited data it is very difficult to know how each patient will react to the surgery, and exactly what to perform on each patient. Research shows that patients with DYT-1 respond the best to any brain surgery, including DBS. Patients with other types of dystonia may be eligible, but not as responisive to brain surgery as those with DYT-1. Also because of the limited data, and because its a relatively new procedure, there is not much known about the long term effects of lesioning procedures, and it is still being studied.