What are the recommended first-line treatment options for managing dystonia in adults?

Recommended first-line treatment options for managing dystonia in adults:

• Adults with problematic dystonia should be referred to a tone or spasticity management service to consider treatment options.

• Enteral anti-dystonic drug treatments are used, but levodopa is not recommended except as a therapeutic trial to identify dopa-responsive dystonia.

• Drugs should not be rapidly withdrawn if used for more than 2 months or at high doses; dosage reduction should be gradual to avoid withdrawal symptoms.

There is no specific first-line oral drug explicitly recommended for dystonia in adults with cerebral palsy in the provided guidelines, but referral to specialist services for tailored management is emphasized.

Botulinum toxin type A may be considered for focal dystonia affecting function, pain, or participation, but this is generally after specialist assessment.