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Arquivos de Neuro-Psiquiatria

versión impresa ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.54 no.1 São Paulo mar. 1996

http://dx.doi.org/10.1590/S0004-282X1996000100025 

Distonias: aspectos terapêuticos

 

Dystonias: therapeutic aspects

 

 

João Carlos Papaterra Limongi

Doutor, Médico Assistente da Divisão de Neurologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

 

 


RESUMO

Diversas abordagens terapêuticas são utilizadas em pacientes com distonias. Sempre que possível, causas específicas devem ser identificadas e tratadas. As modalidades de tratamento sintomático podem ser agrupadas em três categorias: tratamento farmacológico, cirúrgico e injeções locais de toxina botulínica. Cada uma dessas modalidades apresenta algumas vantagens e limitações. Formas generalizadas, particularmente as de ocorrência na infância, podem se beneficiar com drogas anticolinérgicas ou, em alguns casos, com a levodopa ou outros agentes tais como antagonistas da dopamina, baclofeno e benzodiazepínicos. As formas focais não respondem adequadamente ao tratamento farmacológico sistêmico mas beneficiam-se significativamente com injeções de toxina botulínica nos grupos musculares acometidos. Cerca de 90% dos pacientes com blefarospasmo e 70% daqueles com distonia cervical apresentam resposta satisfatória a esse tipo de terapia. O tratamento cirúrgico tem sido utilizado em algumas formas de distonias generalizadas (lesões estereotáxicas), axiais (rizotomias) ou focais (miectomias e neurectomias) com resultados variáveis.

Palavras-chave:distonias, blefarospasmo, distonia cervical, toxina botulínica.


ABSTRACT

Several approaches have been employed for the treatment of dystonias. Possible specific causes should be searched for and specific treatment should be instituted. Different types of symptomatic treatment are grouped according to the following categories: pharmacological systemic therapy, surgical therapy and botulinum toxin injections in the affected muscles. Each of these approaches has its advantages and limitations. Generalized dystonias should be treated with anticholinergic agents. In some cases, levodopa or other drugs such as dopamine antagonists, baclofen and benzodiazepines should be preferred. Focal dystonias respond dramatically to local injections of botulinum toxin. Over 90% of patients with blepharospasm and 70% of patients with cervical dystonia present a satisfactory response to this procedure. Surgical approaches have been utilized in some cases of generalized (stereotaxic lesions), axial (rhizotomies) and focal dystonias (myectomies and neurectomies) with variable results.

Key-words: dystonias, blepharospasm, cervical dystonia, botulinum toxin


 

 

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Aceite: 20-novembro-1995.

 

 

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