68 ORIGINAL ARTICLE Dystonias: rehabilitation Authorship: The Brazilian Association of Physical Medicine and Rehabilitation Final Elaboration: July 30, 2012 Partcipants: Tatane Lopes Teixeira Almeida, Lilian Falkenburg, Maria Angela de Campos Gianni, Maria Inês Paes Lourenção, Maria Inês Nacarato, Tatana Domingues Pedroso, Thaís Tavares Terranova, Lucas Martns de Exel Nunes, Chennyfer Dobbins Paes da Rosa, Marta Imamura, Linamara Rizzo Batstella DESCRIPTION OF THE EVIDENCE COLLECTION METHODOLOGY Artcles in the MedLine (PubMed) database and other research sources were reviewed, with no tme limit. The search strategy used was based on structured questons in the PICO format from the initals: Patent, Interventon, Control and Outcome. The descriptors used were: dystonia and (benzodiazepines or baclofen or tzanidine or clodinine): dystonia and (antcholinergics or haloperidol or lisuride); dystonia and (botulinum toxin); dystonia cervical and (speech therapy or speech pathologist or botulinum toxin); focal dystonia and (botulinum toxin); dystonia and (sensory stmulaton or sensory rehabilitaton); dystonia and (biofeedback or electromyography biofeedback); dystonia and (transcranial magnetc stmulaton); (dystonic disorders or dystonia) and (self help devices or assistve technology or assistve technologies or rehabilitaton); dystonia and (actvity daily living); dystonias and (neurosurgery not intrathecal baclofen) QUALITY OF EVIDENCE AND STRENGTH OF RECOMMENDATIONS: A: Experimental or observatonal studies of highest quality. B: Experimental or observatonal studies of lower quality. C: Case studies (uncontrolled studies). D: Opinion with no cri tcal evaluaton, based on consensus; physiological studies, or animal models. OBJECTIVE: To provide informaton about dystonia and guidance on its treatment and rehabilitaton. PROCEDURES: Therapies for distonia CONFLICT OF INTEREST: The authors have no conficts of interest to declare. INTRODUCTION Movement disorders comprise a group of diseases classifed as extrapyramidal and are associated with involuntary movements or abnormalites of skeletal muscle tone, posture, or both. Movement disorders may be divided into two clinical categories: those that show paucity of movement (hypokinesia), and those with excessive abnormal involuntary movements (hyperkinesia). 1 Dystonias are movement disorders characterized by muscle contractons that cause repettve torsional movements with varying speed, leading to an abnormal posture. The basal ganglia play an important role in the pathophysiology of dystonia, explaining sensorimotor alteratons such as the presence of pain, burning sensatons, and paresthesia, which may precede the onset of muscular contractons. 2 Dystonia can be classifed according to age of onset, etology and anatomical distributon. Based on etology dystonia may be primary, for instance hereditary or sporadic, or secondary, associated with neurological disorders. 1,2 It can be: focal, when it involves only specifc parts of the body, for example blepharospasm and writer’s cramp; segmental, when it involves two or more contguous parts; multfocal, when in involves various unrelated parts of the body; and generalized dystonia involving segmental crural and at least one other part of body. 1,2 The goal of this guideline is to provide recommendatons for the treatment of dystonia. 1. What is the efficacy of muscle relaxants (benzodiazepines, baclofen, tizanidine, clonidine, and anticholinergics) for treating dystonia? In a study conducted with 11 patents with clinical and electromyo- graphic diagnosis of spasmodic tortcollis, the results were compared between treatment with dosages of up to 12 mg/day tzanidine versus placebo for 6 weeks with each drug, with an interval of 1 week between each period. There was no signifcant clinical improvement observed in any of the patents 3 (B). In a study of 19 patents with tardive dyskinesia due to chronic use of neuroleptcs, the efects of clonazepam in dosages of 2 to 4 mg/day were compared with placebo for a period of 12 weeks. A 35% reducton on the dyskinesia scales was observed, being the most obvious beneft for patents in whom dystonic symptoms predominated 4 (B). In a study of 11 patents with Meige syndrome (blepharospasm/ oromandibular dystonia), the use of medicatons intravenously showed signifcant improvement in the blepharospasm indices in response to biperiden and clonazepam injecton. The evaluaton of each patent did not help in predictng the therapeutc potental of these drugs for subsequent oral treatment 5 (A). DOI: 10.5935/0104-7795.20130012