Status dystonicus: the syndrome and its management

被引:133
作者
Manji, H
Howard, RS
Miller, DH
Hirsch, NP
Carr, L
Bahtia, K
Quinn, N
Marsden, CD
机构
[1] UCL Natl Hosp Neurol & Neurosurg, London WC1N 3BG, England
[2] Royal Free Hosp, London NW3 2QG, England
[3] Hosp Sick Children, London WC1N 3JH, England
关键词
status dystonicus; syndrome; management;
D O I
10.1093/brain/121.2.243
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Patients with dystonic syndromes sometimes develop increasingly frequent and relentless episodes of devastating generalized dystonia which we call status dystonicus. Twelve cases of status dystonicus, of various underlying aetiologies, are presented. Possible precipitating factors were identified in only five cases: intercurrent infection (one); discontinuation of lithium (one) and tetrabenazine (one); and the introduction of clonazepam (two). Nine patients required mechanical ventilation and three others were sedated with intravenous chlormethiazole. Drug therapy used included benzhexol, tetrabenazine, pimozide, baclofen, chlorpromazine, haloperidol, carbamazepine and acetozolamide. Two patients underwent thalamotomies, one of whom improved. Two patients died, five returned to their pre-status dystonicus condition, two eventually made a full recovery and three were worse. Patients with status dystonicus should be managed on an intensive care unit as they may develop bulbar and respiratory complications which may require ventilation. Metabolic problems encountered can include rhabdomyolysis with acute renal failure. Drug therapy with benzhexol, tetrabenazine and pimozide or haloperidol may be beneficial in some cases.
引用
收藏
页码:243 / 252
页数:10
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