Table 3.

Management of dystonia in PSP/CBS.

1. Pharmacologic therapy

a. Baclofen started at 5 mg daily, titrating gradually to no more than 10 mg TID

b. Clonazepam starting at 0.25 mg daily, titrating gradually to no more than 3 mg daily

c. Trihexyphenidyl not recommended due to central and peripheral anticholinergic side effects

d. BoNT injections are the most effective treatment for focal dystonia

e. Dystonia and spasticity in CBS may require higher BoNT doses than in other conditions.

2. Non-pharmacologic therapy

a. No formal studies demonstrate benefit of physical therapy for dystonia in PSP/CBS.

b. Occupational therapy may be beneficial for dystonia in PSP/CBS.

(i) Home health assessment

(ii) Evaluation for orthoses such as splints/braces

(iii) Exercises to optimize upper limb function