Diagnostic and therapeutic recommendations in adult dystonia: a joint document by the Italian Society of Neurology, the Italian Academy for the Study of Parkinson's Disease and Movement Disorders, and the Italian Network on Botulinum Toxin

Marcello Romano; Sergio Bagnato; Maria Concetta Altavista; Laura Avanzino; Daniele Belvisi; Matteo Bologna; Francesco Bono; Miryam Carecchio; Anna Castagna; Roberto Ceravolo; Antonella Conte; Giuseppe Cosentino; Roberto Eleopra; Tommaso Ercoli; Marcello Esposito; Giovanni Fabbrini; Gina Ferrazzano; Stefania Lalli; Marcello Maria Mascia; Maurizio Osio; Roberta Pellicciari; Simona Petrucci; Enza Maria Valente; Francesca Valentino; Mario Zappia; Maurizio Zibetti; Paolo Girlanda; Michele Tinazzi; Giovanni Defazio; Alfredo Berardelli

doi:10.1007/s10072-022-06424-x

Diagnostic and therapeutic recommendations in adult dystonia: a joint document by the Italian Society of Neurology, the Italian Academy for the Study of Parkinson's Disease and Movement Disorders, and the Italian Network on Botulinum Toxin

Neurol Sci. 2022 Dec;43(12):6929-6945. doi: 10.1007/s10072-022-06424-x. Epub 2022 Oct 3.

Authors

Marcello Romano¹, Sergio Bagnato², Maria Concetta Altavista³, Laura Avanzino^{4

5}, Daniele Belvisi^{6

7}, Matteo Bologna^{6

7}, Francesco Bono⁸, Miryam Carecchio⁹, Anna Castagna¹⁰, Roberto Ceravolo¹¹, Antonella Conte^{6

7}, Giuseppe Cosentino¹², Roberto Eleopra¹³, Tommaso Ercoli¹⁴, Marcello Esposito¹⁵, Giovanni Fabbrini^{6

7}, Gina Ferrazzano⁶, Stefania Lalli¹⁶, Marcello Maria Mascia¹⁷, Maurizio Osio¹⁸, Roberta Pellicciari¹⁹, Simona Petrucci^{20

21}, Enza Maria Valente^{22

23}, Francesca Valentino²⁴, Mario Zappia²⁵, Maurizio Zibetti²⁶, Paolo Girlanda²⁷, Michele Tinazzi²⁸, Giovanni Defazio^{14

15

16

17}, Alfredo Berardelli^{29

30}

Affiliations

¹ Neurology and Stroke Unit, Villa Sofia Cervello Hospital, Palermo, Italy.
² Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy.
³ Neurology Unit, San Filippo Neri Hospital ASL, Italian Network on Botulinum Toxin (RITB SIN), Rome, Italy.
⁴ Department of Experimental Medicine, Human Physiology Section, University of Genoa, IRCCS San Martino Polyclinic, Genoa, Italy.
⁵ IRCCS San Martino Polyclinic, Genoa, Italy.
⁶ Department of Human Neurosciences, Sapienza University of Rome, Viale dell' Università 30, 00185, Rome, Italy.
⁷ IRCCS Neuromed, Pozzilli, IS, Italy.
⁸ Botulinum Toxin Center, Neurology Unit, Mater Domini University Hospital, Italian Network On Botulinum Toxin (RITB SIN), Catanzaro, Italy.
⁹ Parkinson and Movement Disorders Unit, Study Center On Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy.
¹⁰ IRCCS Fondazione Don Carlo Gnocchi Onlus, Milan, Italy.
¹¹ Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
¹² Department of Brain and Behavioral Sciences, University of Pavia, IRCCS Mondino Foundation, Pavia, Italy.
¹³ Parkinson and Movement Disorders Unit, Department of Clinical Neuroscience, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy.
¹⁴ Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
¹⁵ U.O.C. of Neurophysiology, A.O.R.N. A. Cardarelli, Naples, Italy.
¹⁶ Department of Neurology, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy.
¹⁷ Institute of Neurology, Azienda Ospedaliero Universitaria Di Cagliari, SS 554 km 4.500, 09042, Cagliari, Italy.
¹⁸ Department of Neurology, Luigi Sacco Hospital, University of Milan, Milan, Italy.
¹⁹ Department of Basic Science, Neuroscience, and Sensory Organs, University Aldo Moro, Bari, Italy.
²⁰ Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy.
²¹ Medical Genetics and Advanced Cell Diagnostics Unit, S, Andrea University Hospital, Rome, Italy.
²² Neurogenetics Research Center, IRCCS Mondino Foundation, Pavia, Italy.
²³ Department of Molecular Medicine, University of Pavia, Pavia, Italy.
²⁴ IRCCS Mondino Foundation, Pavia, Italy.
²⁵ Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, Catania, Italy.
²⁶ II University Division of Neurology of A.O. City of Health and Science, Turin, Italy.
²⁷ Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
²⁸ Department of Neuroscience, Biomedicine, and Movement, University of Verona, Verona, Italy.
²⁹ Department of Human Neurosciences, Sapienza University of Rome, Viale dell' Università 30, 00185, Rome, Italy. alfredo.berardelli@uniroma1.it.
³⁰ IRCCS Neuromed, Pozzilli, IS, Italy. alfredo.berardelli@uniroma1.it.

PMID: 36190683
DOI: 10.1007/s10072-022-06424-x

Abstract

The diagnostic framework and the therapeutic management of patients with adult dystonia can represent a challenge for clinical neurologists. The objective of the present paper is to delineate diagnostic and therapeutic recommendations for dystonia provided by a panel of Italian experts afferent to the Italian Society of Neurology, the Italian Academy for the Study of Parkinson's Disease and Movement Disorders, and the Italian Network on Botulinum Toxin. We first discuss the clinical approach and the instrumental assessment useful for diagnostic purpose. Then, we analyze the pharmacological, surgical, and rehabilitative therapeutic options for adult dystonia. Finally, we propose a hospital-territory network model for adult dystonia management.

Keywords: Blepharospasm; Botulinum toxin; Cervical dystonia; Dystonia; Rehabilitation; Upper limb dystonia.

MeSH terms

Adult
Botulinum Toxins* / therapeutic use
Dystonia* / diagnosis
Dystonia* / drug therapy
Dystonic Disorders* / diagnosis
Dystonic Disorders* / drug therapy
Humans
Neurology*
Parkinson Disease* / diagnosis
Parkinson Disease* / drug therapy

Substances

Botulinum Toxins