Clonidine use in the outpatient management of severe secondary dystonia

• Published in: European journal of paediatric neurology 2017-07, Vol.21 (4), p.621-626
• Main Authors: Sayer, C, Lumsden, D.E, Kaminska, M, Lin, J.-P
• Format: Article
• Language: English
• Subjects: Adrenergic alpha-2 Receptor Agonists - therapeutic use; Child; Children; Clonidine; Clonidine - therapeutic use; Dystonia; Dystonic Disorders - drug therapy; Female; Humans; Male; Neurology; Outpatient; Outpatients; Pediatrics; Prospective Studies; Retrospective Studies
• ISSN: 1090-3798; 1532-2130
• DOI: 10.1016/j.ejpn.2017.03.001

Abstract Objective To evaluate the safety, efficacy and effective dosage of clonidine in the outpatient (OP) management of secondary dystonia. Methods A retrospective analysis of children and young people (CAYP) prescribed clonidine in an OP clinic between January 2011 and November 2013 for dystonia management. Of 224 children receiving clonidine, 149/224 did not have a movement disorder and 12/224 had no data leaving 63 movement disorder cases, 15/63 managed as in-patients, 15/48 suffered from tics leaving 33/63 for OP evaluation. Clonidine effectiveness was assessed by ‘yes/no’ criteria in improving 5 areas: seating, sleep, pain, tone and involuntary movements. Results 2/33 motor cases had insufficient data; 7/33 had concurrent therapy leaving 24/33 for analysis. Improvement in at least one area was reported by 20/24 (83%) CAYP: Improved seating tolerance 14/24, and sleep 15/24; reduced pain 15/24; improved tone 16/24 and involuntary movements 17/24. Starting doses ranged from 1 mcg/kg OD to 2 mcg/kg TDS with optimum doses reached on average at 9.5 months follow-up. Maximum dose reached was 75 mcg/kg/day given in 8 divided doses. Average maximum daily dose was 20 mcg/kg/day. The commonest frequency of administration was 8 hourly. Side effects were reported in 11/24 CAYP and discontinued in 1/24 for lack of clinical effectiveness, 1/24 for side effects and 4/24 due to both lack of effectiveness and side effects. Conclusion Clonidine was effective in secondary dystonia management in 83% of cases. A starting dose of 1 mcg/kg TDS was well tolerated and safely escalated. Prospective objective evaluation is now required to confirm the efficacy of clonidine.