21st June 2023

Dystonia

Dystonia is a neurological movement disorder caused by the sudden, uncontrollable contraction of agonists and antagonists of movement, which leads to an abnormal, fixed posture. The causes of dystonia are idiopathic, genetic, or secondary to hypoxic brain injury, stroke, CNS infections, traumatic brain injury, and heavy metal or carbon monoxide poisoning.

Dystonia can affect any muscle in the body but often affects the limbs first and then progresses to other muscle groups. The late stages often affect the neck and facial muscles. Overall, it can involve the face, eyes, neck, vocal cords, torso, limbs and feet. It can eventually cause fixed postures and contractures. It can be associated with pain and fatigue.

There are several types of dystonia:

• Generalised dystonia
• Focal dystonia – affects specific muscles:
  • Blepharospasm
  • Cervical dystonia – also known as torticollis
  • Tardive dystonia – causes slower, twisting movements compared to the fast, chorea-like movements of tardive dyskinesia.
• Multifocal dystonia – affects two or more muscle groups in the body
• Segmental dystonia – affects two or more related muscle groups in the body
• Hemidystonia – affects the same side of the body

The treatments for dystonia are:

• Trihexyphenidyl and benztropine (anticholinergics)
• Benzodiazepines
• Baclofen
• Tetrabenazine (dopamine antagonist)
• Botulinum toxin A – for focal dystonia
• PT and orthotics