What are the current guidelines for the pharmacological management of dystonia in adults?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 22 August 2025Updated: 22 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Pharmacological management of dystonia in adults:

  • Adults with cerebral palsy and problematic dystonia (causing functional problems, pain, or participation issues) should be referred to a tone or spasticity management service to consider treatment options.
  • Levodopa should not be prescribed to manage dystonia in adults with cerebral palsy except in rare cases as a therapeutic trial to identify dopa-responsive dystonia; this is an off-label use.
  • Enteral anti-dystonic drugs should not be rapidly withdrawn, especially if taken for more than 2 months or at high doses; dosage should be reduced gradually to avoid withdrawal symptoms.

These recommendations emphasize individualized assessment and specialist referral for pharmacological treatment of dystonia in adults, with caution regarding levodopa use and withdrawal of anti-dystonic medications.

Note: Specific first-line pharmacological agents for dystonia in adults are not detailed in the provided guidelines, highlighting the importance of specialist involvement.

References:

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