Dystonia: Causes, Symptoms, Diagnosis, Treatment and Complications

Dystonia, a movement disorder, causes muscles to contract irregularly. As a result, there can be jerky or twisting actions.

The terms segmental dystonia, focal dystonia, and general dystonia all relate to the same condition, which affects two or more neighboring body regions. Spasms of the muscles can be moderate or severe. You might feel pain from them, and you might find it challenging to go about your daily tasks.

Although treatment and medication cannot cure dystonia, they can minimize its symptoms. Surgery may be used in people with severe dystonia to block or control nerves or particular brain regions.

Causes Of Dystonia

There is no recognized etiology for dystonia. The way nerve cells in separate sections of the brain communicate with one another, however, might need to be altered. Some forms of dystonia are hereditary.

Dystonia may also be a symptom of one or more other illnesses or ailments, such as:

• Parkinson's
• Huntington's disease
• Wilson disease
• Brain trauma
• Birth trauma
• Stroke
• Brain tumors or specific diseases that emerge in some cancer patients (paraneoplastic syndromes)
• Lack of oxygen or carbon monoxide poisoning
• Infections like encephalitis and TB
• Reactions to specific drugs or heavy metal toxicity

Symptoms Of Dystonia

Different people experience dystonia in different ways. Muscle spasms may:

• Start with one specific location, such as your arm, neck, or leg. After age 21, the face, arm, or neck are the most common places for focal dystonia to begin. It usually remains focal or splits into smaller sections.
• Occur while carrying out a certain action, like handwriting.
• Tension, exhaustion, or anxiety worsen the situation.
• Gradually become more obvious.

The following parts of the body may be affected:

• Cervical dystonia, or the neck. Your head may move to one side, twist, or pull forward or backward as a result of contractions, which may be painful.
• Eyelids. Your eyes close unexpectedly from rapid blinking or muscle spasms, impairing your vision (blepharospasms). Even though spasms are typically not uncomfortable, they may become more severe when you're reading, watching TV, under stress, or engaging with others. Possibly dry, gritty, or light-sensitive, your eyes may feel Oromandibular dystonia.
• Affects the jaw or tongue. Speech slurring, drooling, and trouble swallowing or chewing are all possible symptoms. It can be uncomfortable, and oromandibular dystonia frequently coexists with blepharospasm or cervical dystonia.
• Laryngeal dystonia affects the voice box and vocal cords. Perhaps your voice is strained or whispery.
• Arm and hand. Certain forms of dystonia can only happen when you perform a repetitive task, such as writing (writer's dystonia) or playing a particular musical instrument (musician's dystonia).

Diagnosis Of Dystonia

Your doctor may start the diagnosis of dystonia with a medical history and physical exam.

Your healthcare practitioner may suggest the following to establish whether underlying issues are the source of your symptoms:

• Urine or blood testing. These examinations may show symptoms of toxins or other disorders.
• CT scan or MRI. These imaging examinations can find issues in your brain such as tumors, lesions, or indications of a stroke.
• "EMG," or electromyography. This test measures how electrically active the muscles are.
• A genetic test. Specific genes are linked to specific kinds of dystonia. A person's treatment can be guided by knowing if they carry certain genes.

Treatment Of Dystonia

Your doctor may advise a combination of drugs, treatment, or surgery to treat dystonia.

Medications

Your muscular spasms might be reduced or stopped by botulinum toxin injections (Botox, Dysport, and others) into specific muscles. The usual interval between injections is three to four months.

Usually minor and transient, side effects. Weakness, a dry mouth, or changes in voice are a few examples.

Other drugs target neurotransmitters, which are brain chemicals involved in controlling muscular activity. The following are the choices:

• Duopa, Rytary, and other brands of carbidopa-levodopa. The neurotransmitter dopamine can be elevated by this drug. Additionally, a trial of this medication may be used to aid in the diagnosis of specific forms of dystonia.
• Benztropine with trihexyphenidyl. Other neurotransmitters besides dopamine are affected by these two drugs. Side effects may include forgetfulness, impaired eyesight, sleepiness, and dry mouth. and constipation.
• Deutetrabenazine and tetrabenazine (Xenazine, Austino). These two drugs stop dopamine from working. Sedation, jitters, sadness, or insomnia are examples of possible side effects.
• Baclofen (Lioresal, Gablofen, other brands), clonazepam (Klonopin), and diazepam (Valium, Diastat, etc.). These drugs lessen neurotransmission and could be beneficial for some types of dystonia. Drowsiness is one of their possible adverse effects.

Therapy

Your healthcare practitioner may advise you to:

• To alleviate discomfort and enhance function, consider utilizing either physical therapy or occupational therapy.
• If your voice is affected by dystonia, speech therapy
• To relieve muscle pain, stretch or massage

Surgery

Surgery could be beneficial if your symptoms are severe. Surgery can be used to treat dystonia in a few different ways:

• Deep-brain stimulation. A generator implanted in your chest is coupled to electrodes inserted surgically into a certain region of your brain. Your brain receives electrical pulses from the generator, which could aid in regulating how quickly your muscles contract. To treat your particular condition, you can change the generator's settings.
• Surgery to selectively denervate. Cutting the nerves that regulate muscle spasms is the treatment at hand. If other cervical dystonia therapies haven't been successful, this might be a possibility.

Complications Of Dystonia

Complications can include:

• Physical disabilities that interfere with your ability to accomplish certain duties or daily activities
• Problems with your eyesight that affect your eyelids
• Difficulty moving the jaw, swallowing, or speaking
• Due to your muscles' continual contraction, you may experience pain and weariness.
• Depression, anxiety, and social withdrawal

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