Category	Agents	Key Notes
Dopaminergic	Levodopa/Carbidopa (Sinemet)	MANDATORY trial in all childhood-onset dystonia; dramatic response = DRD
Anticholinergic	Trihexyphenidyl	Most effective oral agent for generalized dystonia; titrate slowly
GABA-ergic	Baclofen (oral or intrathecal), Clonazepam	ITB pump for mixed spasticity-dystonia
VMAT2 Inhibitors	Tetrabenazine, Deutetrabenazine	Deplete monoamines; no tardive risk; useful in hyperkinetic combined dystonias
Botulinum Toxin	BoNT-A injections	Standard of care for focal/segmental dystonia
Neuromodulation	GPi-DBS	Best for TOR1A (50–90% improvement), KMT2B (excellent), SGCE (good)

Adverse effects: dry mouth, urinary retention, cognitive changes. Contraindication: narrow-angle glaucoma.

Week	AM	Midday	PM
Week 1	½ tab	—	—
Week 2	½ tab	—	½ tab
Week 3	½ tab	½ tab	½ tab
Week 4	1 tab	½ tab	½ tab
Week 5	1 tab	1 tab	½ tab
Week 6+	1 tab	1 tab	1 tab

DRD response expected within days to 2 weeks. Give last dose ≤1600. Separate from iron supplements by ≥2 hours.

Myoclonus-dystonia (DYT-SGCE) shows a parent-of-origin effect because SGCE is: