tolerated than the traditional muscle relaxants. Baclofen and clonazepam, two drugs commonly used for dystonia and spasticity in other disorders, can also help those symptoms in CBD. The most common side effect of these drugs is sleepiness and baclofen can also cause muscle weakness, which could contribute to falls. If it is a bothersome symptom, the myoclonus of CBD, may respond to clonazepam or levitiracetam.
The dystonia of CBD may respond to injections of botulinum toxin( Botox and other brands) into the affected muscles, especially for involuntary eyelid closure(“ blepharospasm”). Botulinum toxin may also help limb or neck rigidity in CBD, but higher doses are required than in other disorders because in CBD, spasticity may also be present. While botulinum toxin can improve flexibility and pain in the dystonia of CBD, actual improvement in functional ability is unlikely. Injections into neck muscles must be done with caution, as the fluid can spread into nearby swallowing muscles, which may already be impaired by the disease process.
Generally, the greatest benefit to CBD offered by medication comes from treating specific symptoms in the same way they would be treated if occurring as part of some other disease. Neurologists are familiar with these measures even if they are unfamiliar with CBD. Your doctor will work with you closely to try different medications, timing and dosages to maximize the benefits for your symptoms while also trying to minimize side effects.
What else besides medications can help to manage the symptoms of CBD? Unfortunately, none of the surgical approaches that can help Parkinson’ s, such as deep brain stimulation, pallidotomy or focused ultrasound, help CBD. However, cardiovascular exercise can slow the progression of motor decline in most neurodegenerative conditions and exercise is a very important part of disease management for people with CBD. Physical, occupational and speech therapy are also important pillars of treatment to address many of the symptoms and challenges faced by people living with CBD, such as speaking, swallowing, balance and daily activity performance. Home safety evaluations performed by trained physical and occupational therapists are extremely useful to help prevent falls and to recommend adaptive equipment such as grab bars, shower chairs, walkers or wheelchairs.
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Devices to support the affected body part are also recommended, as are orthotic devices to slow the progression of dystonic posturing. An exception is dental splints for jaw dystonia, which are generally not tolerated by those with CBD.
Much more on the drug and non-drug treatment of symptoms of CBD can be found in a peerreviewed journal article,“ Best Practices in the Clinical Management of Progressive Supranuclear Palsy and Corticobasal Syndrome: A Consensus Statement of the CurePSP Centers of Care.” It is available for free at: www. frontiersin. org / articles / 10.3389 / fneur. 2021.694872 / full