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adults (levodopa with a decarboxylase inhibitor). The second choice in patients unresponsive to levodopa are anticholinergic agents. High-dosage anticholinergics have become the main palliative treatment in dystonia.23

Approximately 50% of children and 40% of adults with idiopathic dystonia obtain moderate to dramatic benefit from their use. The main dose-limiting factors are the peripheral and central adverse effects of anticholinergics. Peripheral effects, such as dry mouth and blurred vision, are common but can be neutralized by co-administration of a peripherally acting anticholinesterase drug, such as pyridostig-mine bromide (Mestinon) and pilocarpine eyedrops, muscarinic agonists. Central effects (hallucinations, confusion, memory decline) can be overcome by reducing the dose. High-dose baclofen appears to be the most effective medication after the anticholin-ergics.24

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