title: Clonidine use in the outpatient management of severe secondary dystonia.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Complex Motor Disorders Service, Evelina London Children's Hospital, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Sayer
authors.affiliation: Complex Motor Disorders Service, Evelina London Children's Hospital, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK.
authors.forename: D E
authors.initials: DE
authors.lastname: Lumsden
authors.affiliation: Complex Motor Disorders Service, Evelina London Children's Hospital, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Kaminska
authors.affiliation: Complex Motor Disorders Service, Evelina London Children's Hospital, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK. Electronic address: jean-pierre.lin@gstt.nhs.uk.
authors.forename: J-P
authors.initials: JP
authors.lastname: Lin
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000627:therapeutic use*; D002648:Child; D003000:Clonidine / Q000627:therapeutic use*; D020821:Dystonic Disorders / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D010045:Outpatients; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D003000:Clonidine
keywords: Children; Clonidine; Dystonia; Outpatient