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Neuroscience Center

Dystonia

Dystonia is a movement disorder that can affect different parts of the body with muscle contractions, involuntary twisting and repetitive movements. Early symptoms may include a deterioration in handwriting after writing several lines, foot cramps, and/or a tendency of one foot to pull up or drag. The neck may turn or pull involuntarily, especially when the patient is tired or stressed.

Sometimes both eyes will blink rapidly and uncontrollably, rendering a person functionally blind. Other possible symptoms are tremor and voice or speech difficulties. The initial symptoms can be very mild and may be noticeable only after prolonged exertion, stress or fatigue. They may progress over time, or they may not.

Understanding Dystonia

Dystonias are classified according to the parts of the body they affect:

  • Generalized dystonia affects most or all of the body.
  • Focal dystonia is localized to a specific part of the body.
  • Multifocal dystonia involves two or more unrelated body parts.
  • Segmental dystonia affects two or more adjacent parts of the body.
  • Hemidystonia involves the arm and leg on the same side of the body.

Those listed below are a combination and are defined as specific syndromes.

  • Cervical Dystonia Also called torticollis, cervical dystonia is the most common of the focal dystonias. In torticollis, the muscles in the neck twist and turn to one side or pull forward or backward. Torticollis can occur at any age, although most individuals first experience symptoms in middle age.
  • Blepharospasm The second most common focal dystonia is the involuntary, forcible closure of the eyelids, known as blepharospasm. The spasms may leave the eyelids completely closed, basically causing blindness even though the eyes and vision are normal.
  • Writer's Cramp This type of dystonia affects the muscles of the hand and sometimes the forearm, and only occurs during handwriting. Similar focal dystonias have also been called typist's cramp, pianist's cramp, and musician's cramp.
  • Dopa-responsive Dystonia (DRD) Dopa-responsive dystonia typically begins in childhood or adolescence with progressive difficulty in walking and, in some cases, spasticity. The symptoms may change throughout the day from relative mobility in the morning to increasingly worse disability in the afternoon and evening, as well as after exercise. The diagnosis of DRD mimics symptoms of cerebral palsy.

Treating Dystonia

Treatment often is limited to minimizing the symptoms as there is no successful cure for the cause of dystonia. Medications may be prescribed, but not all patients respond well to the same medications. One promising therapy for treating the symptoms of dystonia is botulinum toxin, more commonly known as BOTOX.

Small amounts of this toxin can be injected into the muscles to provide temporary relief of focal dystonias. The toxin stops muscle spasms by weakening the muscle. The effect lasts for three to six months before the injections have to be repeated.  This treatment has gained wider acceptance among physicians based on how well they’ve worked for patients in the past.

For a referral to a Washington University neurologist or neurosurgeon at Barnes-Jewish Hospital, call .

Brad Racette, MD

Neurologist, Barnes-Jewish & Washington University Neuroscience Center

 

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