Dystoni

Dystonia is a movement disorder that causes the muscles to contract involuntarily. Dystonia may affect any parts of your body (general dystonia). The muscle spasms can range from mild to severe. They may be painful and they can interfere with the performance of daily tasks.

There is no cure for dystonia, but medications and therapy can improve symptoms. Surgery is sometimes used to disable or regulate nerves or certain brain regions in patients with severe dystonia.

Symptoms

Dystonia affects different people in different ways. Muscle spasms might:

Begin in a single area, such as leg, neck or arm. Focal dystonia that begins after age 21 usually starts in the neck, arms or face. It may remain focal or become segmental.
Occur during a specific action, such as writing by hand.
Worsen with stress, fatigue or anxiety.
Become more noticeable over time.

Areas of the body that can be affected include:

Neck (cervical dystonia). Contractions cause the head to twist and turn to one side, or pull forward or backward, sometimes causing pain.
Eyelids. Rapid blinking or spasms cause your eyes to close (blepharospasms) and make it difficult to see. Spasms usually aren’t painful but might increase when you’re in bright light, while reading, watching TV, under stress or interacting with people. Your eyes might feel dryness, dusty or sensitive to light.
Jaw or tongue (oromandibular dystonia). You might experience slurred speech, and difficulty in chewing or swallowing. Oromandibular dystonia may be painful and often occurs in combination with cervical dystonia or blepharospasm.
Voice box and vocal cords (laryngeal dystonia). You might have a tight or whispering voice.
Hand and forearm. Some types of dystonia occur while you do a repetitive activity, such as writing (writer’s dystonia) or playing a musical instrument (musician’s dystonia). Symptoms usually do not occur when your arm is at rest.

When to see a doctor

Early signs of dystonia often are mild, occasional and linked to a specific activity. See your doctor if you’re having involuntary muscle contractions.

Causes

The exact cause of dystonia isn’t known. But it might involve changes in nerve cells in several regions of the brain. Some forms of dystonia are passed down for generations.

Dystonia can also be a symptom of another disease or condition, including:

Parkinson’s disease;
Huntington’s disease;
Wilson’s disease;
Traumatic brain injury;
Birth injury;
Stroke;
Brain tumor or certain disorders that develop in some people with cancer (paraneoplastic syndromes);
Oxygen deprivation or carbon monoxide poisoning;
Infections, such as tuberculosis or encephalitis;
Reactions to certain medications or heavy metal poisoning;

Complications

Depending on the type of dystonia, complications can include:

Physical disabilities that affect your performance of daily activities or specific tasks
Difficulty with vision that affects movement of your eyelids
Difficulty with jaw movement, swallowing or speech
Pain and fatigue, due to constant contraction of muscles
Depression, anxiety and social isolation

Diagnosis

To diagnose dystonia, your doctor first studies your medical history and conducts physical examination.

To determine if underlying conditions are causing your symptoms, your doctor might recommend:

Blood or urine tests. These tests can reveal signs of toxins or of other conditions.
MRI or CT scan. These imaging tests can identify problems in the brain, such as tumors, lesions or signs of a stroke.
Electromyography (EMG). This test measures the electrical activity within muscles.
Genetic testing. Some forms of dystonia are related to certain genes. Knowing whether you have these genes can help in guiding treatment.

Treatment

To manage dystonia, your doctor might recommend a combination of medications, therapy or surgery.

Medications

The most effective method of treating dystonia is botulinum toxin injection into the affected muscles. A positive clinical effect is observed in 85-90% of cases and lasts for 3-6 months. Botulinum toxin is successfully used in 60 countries of the world, including Georgia, for the treatment of dystonia.

Injections of botulinum toxin (Botox, Dysport, others) into specific muscles might reduce or stop your muscle spasms. Injections are usually repeated every 3 to 4 months.

Side effects are generally mild and temporary. They can include weakness, dry mouth or voice changes.

Botox

Botox injections use a toxin to prevent a muscle from moving for a certain time. These toxins are often used to smooth wrinkles on the face. They are also used to treat neck spasms, sweating, overactive bladder, lazy eye, migraine and other conditions.

The medicine used in Botox injections is made from the same toxin that causes a type of food poisoning called botulism. But the forms of purified botulinum toxin used by licensed health care providers meet medical control standards. These standards were approved by the US Food and Drug Administration. As a rule, the bacteria toxins used for medical purposes are not harmful if used correctly.

Why Botox?

Botox injections block certain chemical signals from nerves that cause muscles to contract. These injections are most commonly used to relax the facial muscles that cause frown lines and other facial wrinkles.

Botox injections also are used to ease symptoms of some health conditions. It’s not a medication. Medical conditions that might be treated with Botox injections include:

Neck spasms. During neck spasms, the neck muscles contract in an uncontrolled way. This causes the head to twist or turn into an uncomfortable position. The condition also is called cervical dystonia.
Other muscle spasms. Cerebral palsy and other conditions of the nervous system can cause the limbs to pull in toward the center of the body. Muscle spasms also can cause eye twitching.
Amblyopic / lazy eye. The most common cause of lazy eye is an imbalance in the muscles used for moving the eye. Lazy eye also is called crossed eyes or misaligned eyes.
Sweating. Botox might be used for a condition in which people sweat a lot even when it is not hot. It is called excessive sweating or hyperhidrosis.
Migraine. Botox injections may help reduce frequency of migraine. This treatment is used mainly for people who have headaches 15 or more days a month. A condition of frequent and severe headaches is called chronic migraine. Treatment is needed about every three months to achieve effective results.
Bladder problems. Botox shots can also help reduce urinary incontinence caused by an overactive bladder.

Other medications target chemicals in your brain (neurotransmitters) that affect muscle movement. The medication options include:

Carbidopa-levodopa (Duopa, Rytary, others). This medication can increase levels of the neurotransmitter dopamine. This drug may also be used as a trial to help diagnose certain types of dystonia.
Trihexyphenidyl and benztropine. These two medications act on neurotransmitters other than dopamine. Side effects can include memory loss, blurred vision, drowsiness, dry mouth and constipation.
Tetrabenazine (Xenazine) and deutetrabenazine (Austedo). These two medications block dopamine. Side effects can include sedation, nervousness, depression or insomnia.
Diazepam (Valium, Diastat, others), clonazepam (Klonopin) and baclofen (Lioresal, Gablofen, others). These medications reduce neurotransmission and might help some forms of dystonia. They may cause side effects, such as drowsiness.

Therapy

Your doctor might suggest:

Physical therapy or occupational therapy or both to help ease symptoms and improve function
Speech therapy if dystonia affects your voice
Stretching or massage to ease muscle pain

Surgery

If your symptoms are severe, surgery might help. There are a few types of surgery to treat dystonia:

Deep brain stimulation. Electrodes are surgically implanted into a specific part of your brain and connected to a generator implanted in your chest. The generator sends electrical pulses to your brain that might help control your muscle contractions. The settings on the generator can be adjusted to treat your specific condition.
Selective denervation surgery. This procedure involves cutting the nerves that control muscle spasms. This option might be used when other treatments for cervical dystonia are not effective.