Dystonia is a neurological condition that involves spasms and sustained muscle contractions which result in abnormal movement and postures.
These spasms may affect only one muscle, a group of muscles or the entire body. They result from abnormalities in the basel ganglia in the brain. Similar excess movements may be experienced by people with Parkinson’s disease as well.
Types of dystonia are usually classified by the location in the body and include:
- Generalized dystonia
- Torticollis (twisting of neck)
- Bradykinesia (slow movement)
- Meige syndrome
- Oromandibular dystonia
- Spasmodic dysphonia
- Writer’s cramp
The most common type of dystonia is cervical dystonia, or torticollis, in which the muscles of the head and neck develop sustained contractions that commonly result in twisting of the neck. Patients complain of pain, fatigue and soreness in the muscles and may end up in severely distorted postures. In other patients, the neck movements are more spasmodic.
About 300,000 people are estimated to have dystonia, although many of them are estimated to be incorrectly diagnosed because of the similarities to other conditions like muscular dystrophy, Huntington disease and amyotrophic lateral sclerosis (ALS).
Dystonia symptoms can begin with deterioration in handwriting, foot cramps, a tendency to pull or drag one foot after walking or running, or turning the neck. Symptoms also include tremor and voice or speech problems.
At first dystonia symptoms may be mild and occur only after fatigue, stress or exertion. They can be intermittent or can even plateau, depending on the type of dystonia.
Dystonia symptoms may appear between the ages of 5 and 16 or may not appear until early adulthood. Secondary dystonias due to injury or stroke can appear at any time.
The main goal of dystonia treatment is to keep movements as normal as possible with the smallest amount of medication, since many medications can cause side effects.
Injections of botulinum toxin may be the most desirable therapy. The drug weakens certain muscles and lasts several months.
Therapies may be necessary to help patients with language and movement.
Cases that do not respond to medication may require surgery, often aimed at interrupting abnormal movements.
Dystonia Treatment: Surgical Options
One dystonia treatment procedure is pallidotomy, a computer-assisted neurosurgery, aimed at reducing tremor, rigidity and other symptoms by destroying the areas of the brain that caused these symptoms. Another option is thalamotomy, which involves making a lesion in the thalamus, the area of the brain that is the source of tremor. Both procedures are irreversible and may have permanent side effects.
Deep brain stimulation (DBS) is a procedure where electrodes are placed in specific areas of the brain. The electrodes block the abnormal brain circuitry seen in patients with neurological conditions such as Parkinson’s disease, tremors and dystonia.
DBS does not destroy the overactive cells, like other movement disorders treatments such as pallidotomy and thalamotomy surgeries. Rather, it temporarily blocks the abnormal signals and is a reversible process. In DBS, a lead is permanently implanted into your brain and connected to a generator, which is attached under the skin of your chest.
Wake Forest Baptist Multidisciplinary Approach
The treatment of movement disorders at Wake Forest Baptist is a collaborative effort between neurologists and neurosurgeons.
Quality of life is further enhanced by the participation of physical, occupational and speech therapists, and otolaryngologists who have special expertise in speech and swallowing difficulties.