Utility of high-dose clonidine in managing pediatric dystonia: A case series in a multi-ethnic Asian population

Abstract

Background: Dystonia is a debilitating movement disorder. Clonidine, an alpha-2 agonist, is reported to be beneficial for pediatric dystonia. The use of high-dose clonidine remains poorly documented. We aimed to describe our experience with high-dose clonidine.

Methods: Dystonia-Severity-Action- Plan (DSAP) is used to evaluate the severity of dystonia.

Results: The clinical information of five children, seen at KK Hospital between 2019 and 2023, on high-dose clonidine were reviewed and reported. High-dose clonidine was effective in the management of severe exacerbations of dystonia, with an improvement in DSAP scoring. Clonidine may be administered enterally, intravenously, and through the transdermal route. The median dose reported was 2 mcg/kg/h, with doses up to 6 mcg/ kg/h. Adverse effects reported were dose-dependent and include bradycardia, hypotension, sedation, and application site reaction.

Conclusion: High-dose clonidine is effective in improving severe dystonia in our multi-ethnic Asian population, and well tolerated. Our experience complements the existing data and suggest that high- dose clonidine can be considered in the management of pediatric dystonia and status dystonicus.