Dystonia: Types, Symptoms, Causes and Treatments

Dystonia is a movement disorder with involuntary muscle contractions resulting in repetitive movements or twisting movements of the affected body part. It affects a single muscle, a group of muscles or the entire body. 

Dystonia can be classified as follows:

1. Generalised Dystonia: All parts of the body are affected.
2. Focal Dystonia: A single part of the body is affected.
3. Multifocal Dystonia:Two or more different parts of the body are affected.
4. Segmental Dystonia: Two or more adjacent parts of the body are affected.
5. Inherited: It is caused by mutations in the gene.
6. Secondary: It is caused due to injury to the brain, drug reaction or metabolic disorder.
7. Idiopathic: The reason for this type of dystonia is unknown.
8. Abdominal Dystonia: Muscle contractions in the abdomen are repetitive and painful.
9. Blepharospasm (Eye Dystonia): Muscle contractions in the eye are painful and repetitive.
10. Focal Hand Dystonia: Muscle contractions in hand.
11. Neck Dystonia (Cervical Dystonia): Muscle contractions of the head and neck are abnormal, repetitive, and painful.

Depending upon the type of Dystonia, the symptoms vary. It includes:

1. Foot cramps
2. Shaking movements
3. Twisting movements
4. Tremors
5. Twitching of eyes
6. Involuntary blinking
7. Uncontrolled movements of legs, hands, neck
8. Involuntary pulling
9. Lack of coordination during walking or running 
10. Difficulty in coordinating body movements
11. Muscle spasms etc.

Genetic, Environmental factors and health conditions are both responsible for causing Dystonia.

1. Genetic changes are inherited and present from birth.
2. Environmental factors include lack of oxygen to the brain and exposure to heavy metals.
3. Health conditions like: 
   1. Cerebral Stroke
   2. Encephalitis
   3. Wilson's disease
   4. Brain tumour and traumatic brain injury. 

Factors that can lead Dystonia are:

1. Antipsychotic drugs
2. Infections
3. Lead poisoning
4. Family history
5. Extreme hand movements in case of playing musical instruments etc

There are no drugs that can prevent or decrease the progression of dystonia. Few lifestyle modifications may help to ease symptoms of Dystonia. It includes:

1. Adapting to these lifestyle modifications may improve quality of life.
2. Heat or cold treatment to ease muscle pain.
3. Yoga and meditation, and deep breathing to ease stress.
4. Biofeedback: In this technique, electronic devices are used to monitor body functions such as muscle tension, heart rate and blood pressure, which may help to reduce muscle tension and stress.
5. Speech therapy in case of dystonia affects speech.
6. Physical therapy or occupational therapy to ease and improve function.
7. Massage or stretching exercises to ease muscle pain. 

It includes both physical examination and medical history.

1. Blood or urine test: To test toxins and infections.
2. MRI or CT scan: To find abnormalities in the brain such as tumours, lesions and evidence of stroke.
3. Electromyography(EMG): To measure electrical activity within the brain.
4. Genetic testing: Some genes are responsible for causing some types of dystonia testing for those genes may help detect dystonia.

Treatment with Medications

1. Botulinum toxin injection into the specific muscle decreases muscle contractions and corrects abnormal postures. This injection is repeated every three to four months.
2. Other medications that target chemicals that are responsible for affecting muscle movements are Carbidopa and levodopa which increase dopamine levels.
3. Trihexyphenidyl and benztropine act on neurotransmitters different from dopamine. Side effects include blurred vision, dizziness, constipation, involuntary bladder, and pain during urination.
4. Diazepam to reduce neurotransmission.

Surgery 

Surgery is performed if the Dystonia is severe or if the patient is not responding to the treatment by drugs.

1. Deep Brain Stimulation: Electrical pulses are sent to certain brain parts that may help control muscle contractions.
2. Pallidotomy: In this technique, the region in the brain which is responsible for controlling voluntary movements is destroyed, which results in the control of involuntary muscle contracting and twisting.
3. Thalamotomy: In this technique, the egg-shaped structure in the middle of the brain called the thalamus is destroyed, which decreases symptoms like tremors and rigidity.

Make an appointment with the doctor before the consultation.

1. Note the symptoms experienced by you.
2. Note the medications along with supplements used.
3. Note the medical history and personal information before visiting the doctor.
4. Note the questions to be asked.
5. Ask whether the condition is temporary or permanent.
6. What are the side effects one can expect after the treatment?

What can the Doctor ask?

1. When did the first symptoms appear?
2. How long have you been experiencing the symptoms?
3. How severe is the symptom?
4. Familial history of the disease?
5. Exposure to any chemicals?

1. Physical impairments that limit your ability to perform daily activities 
2. Vision problems that affect eyelids. 
3. Difficulty in swallowing, movement of jaw and speaking difficulties.
4. Constant muscle contraction results in pain and tiredness. 
5. Anxiety, depression, and social withdrawal