Dystonic storm: a practical clinical and video review

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

DYSTONIA SPECIFIC Rx^a	SUPPORTIVE Rx
Anticholinergics	1st line: IV midazolam
DA receptor blockers^b	2nd line: Propofol
TBZ	3rd line: Non-depolarizing neuromuscular blockers or Barbiturates
Clonidine
Baclofen + Assorted drugs

^aCombination is typically required
^bShould be avoided when dystonic storm developing from underlying tardive dystonia
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
Abbreviations: DA dopamine, IV intravenous, Rx treatment, TBZ tetrabenazine

ISSN: 2054-7072