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Table 4 Dystonia-specific and supportive therapies: thought process for the next 2–4 weeks

From: Dystonic storm: a practical clinical and video review

DYSTONIA SPECIFIC Rxa SUPPORTIVE Rx
Anticholinergics 1st line: IV midazolam
DA receptor blockersb 2nd line: Propofol
TBZ 3rd line: Non-depolarizing neuromuscular blockers or Barbiturates
Clonidine
Baclofen + Assorted drugs
  1. aCombination is typically required
  2. bShould be avoided when dystonic storm developing from underlying tardive dystonia
  3. This table demonstrates the list of dystonia-specific and supportive therapies. Dystonia-specific medications alone are often ineffective in isolation to control dystonic storm. Combinations of drugs are generally required. Intravenous midazolam is typically employed as a first-line agent, whereas propofol is second-line. In refractory cases, third-line agents include non-depolarizing neuromuscular blocking agents (such as pancuronium) or barbiturates
  4. Abbreviations: DA dopamine, IV intravenous, Rx treatment, TBZ tetrabenazine