Snaith Ailsa, Wade Derick
Oxford Radcliffe Hospitals Trust, Oxford, UK.
BMJ Clin Evid. 2011 Jun 13;2011:1211.
Dystonia is usually a lifelong condition with persistent pain and disability. Focal dystonia affects a single part of the body; generalised dystonia can affect most or all of the body. It is more common in women, and some types of dystonia are more common in people of European Ashkenazi Jewish descent.
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments, surgical treatments, and physical treatments for focal, and for generalised dystonia? We searched: Medline, Embase, The Cochrane Library, and other important databases up to February 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 15 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: acetylcholine release inhibitors (botulinum toxin), acupuncture, anticholinergic/antihistaminic drugs, anticonvulsants, atypical antipsychotic drugs, benzodiazepines, biofeedback, chiropractic manipulation, deep brain stimulation of thalamus and globus pallidus, dopaminergic agonists and antagonists, gamma-aminobutyric acid (GABA) analogues, microvascular decompression, muscle relaxants, myectomy, occupational therapy, osteopathy, pallidotomy, physiotherapy, selective peripheral denervation, serotonergic agonists and antagonists, speech therapy, and thalamotomy.
肌张力障碍通常是一种伴随持续疼痛和功能障碍的终身性疾病。局限性肌张力障碍影响身体的单个部位；全身性肌张力障碍可影响身体的大部分或全部。女性更为常见，某些类型的肌张力障碍在欧洲阿什肯纳兹犹太裔人群中更为常见。
我们进行了一项系统评价，旨在回答以下临床问题：药物治疗、手术治疗和物理治疗对局限性和全身性肌张力障碍的效果如何？我们检索了：截至2011年2月的Medline、Embase、Cochrane图书馆及其他重要数据库（临床证据综述会定期更新；请查看我们的网站获取本综述的最新版本）。我们纳入了来自美国食品药品监督管理局（FDA）和英国药品及医疗产品监管局（MHRA）等相关组织的危害警示。
我们找到了15项符合我们纳入标准的系统评价、随机对照试验或观察性研究。我们对干预措施的证据质量进行了GRADE评估。
在本系统评价中，我们提供了以下干预措施的有效性和安全性相关信息：乙酰胆碱释放抑制剂（肉毒毒素）、针灸、抗胆碱能/抗组胺药物、抗惊厥药物、非典型抗精神病药物、苯二氮䓬类药物、生物反馈、整脊手法、丘脑和苍白球深部脑刺激、多巴胺能激动剂和拮抗剂、γ-氨基丁酸（GABA）类似物、微血管减压术、肌肉松弛剂、肌切除术、职业治疗、整骨疗法、苍白球切开术、物理治疗、选择性周围神经切断术、5-羟色胺能激动剂和拮抗剂、言语治疗以及丘脑切开术。
