People with dystonia experience involuntary muscle spasms or contractions. These result in twisting or jerking movements, and unusual body positions/postures. Dystonia can affect almost any part of the body, however, only one area is often affected.
The common presentations are:
• Neck muscle contractions lead to abnormal head turning, tilting or twisting, often combined with shaking or jerking movements referred to as cervical dystonia aka torticollis.
• Facial muscle contractions resulting in excessive blinking or eye lid spasms, called blepharospasm. When this occurs together with lower facial spasms, it is referred to as Meige syndrome. Involuntary muscle spasms or contractions of the jaw and/or tongue are known as oromandibular dystonia.
• When these involuntary contractions involve the vocal cords – the voice becomes strained and breathy referred to as spasmodic dysphonia or laryngeal dystonia.
• Other commonly affected areas include the hand or foot. Sometimes the dystonia is associated with specific activities (task-specific dystonias) such as when writing in writer’s cramp or when playing a musical as in guitarist or violinist dystonia.
• Dystonia can be generalized (affecting whole body or several body areas) – more common with childhood onset, focal (neck, hand, eyelids, jaw) or just one side of the body (hemi-dytonia).
There are various causes for dystonia. Among these are genetic or hereditary causes (runs in the family) and acquired causes from event occurring during ones life such as brain injury, infection or exposure to drugs or other toxins. However, the most causes of dystonia remain unclear.
Dystonia is thought to result from an abnormality in or damage to the basal ganglia or other brain regions that control movement and abnormalities in the way the brain processes information and generates commands to move.
This is made by a neurologist, often one specializing in movement disorders based on examination and history about your symptoms. This might include investigations such as brain scan, blood and/or urine tests in some cases. It is not uncommon for mild dystonia may go undiagnosed or misdiagnosed for a while.
You dystonia might be treatable if an underlying cause is found and such a case a more specific management plan will be discussed with you. For most other dystonia syndromes, these medications might provide some symptomatic relief and often used on a trial-and-error basis:
• Levodopa-carbidopa (Levocarb)
• Anti-cholinergics (trihexyphenidyl)
• Benzodiazepines (clonazepam, diazepam)
• Muscle relaxants (cyclobenzaprine)
Some people may benefit from botulinum toxin injections especially those with focal dystonias (neck, eyelid, jaw, tongue or limb). These injections should be administered by medical experts. Botulinum toxin injections temporarily weaken muscles to relieve the contractions/spasms and usually need to be injected every 3 to 4 months.
Various non-pharmacological strategies including behaviour and adaptive postural strategies, stretching and relaxation exercises, massage and physiotherapy including heat application can be very helpful in the management of symptoms.
Surgery (including deep brain stimulation) is another option for more severe or dystonia not responsive to the above.
Dystonia typically develops over a period of a few months or a few years but generally does not continue to get worse but may spread from one body region to another or additional symptoms may develop.
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