Paramedical treatment in primary dystonia: A systematic review

• Published in: Movement disorders Vol. 24; no. 15; pp. 2187 - 2198
• Main Authors: Delnooz, Cathérine C.S., Horstink, Martin W.I.M., Tijssen, Marina A., van de Warrenburg, Bart P.C.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 15.11.2009
• Subjects: allied health; biofeedback; Databases, Factual - statistics & numerical data; dystonia; Dystonic Disorders - rehabilitation; Humans; Language Therapy - methods; paramedical; physical therapy; Physical Therapy Modalities; Randomized Controlled Trials as Topic; rehabilitation; sensorimotor training; Severity of Illness Index; Speech Therapy - methods
• ISSN: 0885-3185; 1531-8257
• DOI: 10.1002/mds.22608

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