Dystonia: Types, Symptoms, Complications and Treatment

Overview 

Multiple disorders may affect the normal movement of the human body. These disorders may happen due to a malfunctioning nervous system or genetic reasons. Let us delve deep into one of the significant movement disorders, dystonia, to understand it better and catch the signs early. This blog is a comprehensive guide on dystonia, its symptoms and treatment options.  

What is dystonia? 

Dystonia is a movement disorder that creates uncontrollable muscle contractions. The specific body part affected by dystonia twists involuntarily due to the contraction, leading to repetitive motions or strange postures. Dystonia may affect one muscle, a set of muscles, or the entire body. About 1% of people have dystonia, and women are more likely than men to get it. 

What signs and symptoms indicate dystonia? 

Symptoms of dystonia may be either very subtle or extremely severe. Different body parts may be affected by dystonia, and the condition’s symptoms frequently change over time. Some early signs are cramping of the foot, involuntary neck spasm, uncontrollable blinking of the eyes or difficulty speaking.  

The symptoms may appear or get worse due to stress or exhaustion. Because the muscles constantly contract, people with dystonia frequently complain of pain and tiredness. Usually, it is during early adulthood that dystonia starts manifesting, and it starts in the upper body. Over time, the symptoms gradually develop. Early-onset adult dystonia is segmental or focal, affecting one specific body part or the nearby parts. 

When dystonia symptoms manifest in children, it usually shows up first in the foot or hand, but they soon progress to the rest of the body after that. 

Why does dystonia occur? 

The majority of dystonia instances lack a clear cause. The basal ganglia, a part of the brain, appear to be the source of dystonia. This part of the brain is in charge of initiating  muscular contractions. A glitch in the communication between nerve cells is the cause.  

Dystonia can also be symptom of another disease, like:

• Huntington’s disease 
• Parkinson’s disease
• Stroke
• Traumatic brain injury
• Wilson’s disease
• Birth injury
• Brain tumor or some disorders that develop in some individual with cancer (paraneoplastic syndromes)
• Carbon monoxide poisoning or oxygen deprivation 
• Infections, like encephalitis or tuberculosis 
• Reactions to some medicines or heavy metal poisoning

Primary dystonia or dystonia, which occurs due to an unknown cause, is frequently passed down from parents. Some people who have the condition in the genes may never develop dystonia. Additionally, even among family members, the symptoms can differ significantly. 

What are the different types of dystonia? 

By the body part they impact, dystonia is categorised into various types. They are: 

1. Generalised dystonia: The entire body may be affected by generalised dystonia. 
2. Focal dystonia: Only one portion of the body is impacted by focal dystonia. 
3. Multifocal dystonia: Multiple disconnected body parts are impacted by multifocal dystonia. 
4. Segmental dystonia: Adjacent body parts are affected by segmental dystonia. 
5. Hemi dystonia: When dystonia affects both arms and legs on the same side of the body, it’s called Hemi dystonia. 

Based on their patterns, dystonia can also be classed as a syndrome: 

• Blepharospasm: This is a form of dystonia that impacts the eyes. Uncontrollable blinking frequently marks the beginning of it. Usually, during the initial stages, it only affects one eye. But eventually, both eyes are impacted. The eyelids unconsciously close due to the spasms, and sometimes, the condition makes them stay closed. The affected person may see clearly even if the blinking happens. However, they may become functionally blind if the eyelids close permanently. 
• Torticollis: This type of cervical dystonia is most prevalent in middle-aged people.  Due to cervical dystonia, the neck muscles may get affected, and the head may turn and move backwards or forwards.  
• Cranial dystonia: Muscles in the head, face, and neck are impacted by cranial dystonia. 
• Oromandibular dystonia: The jaw, lips, and tongue muscles spasm due to this dystonia. For people affected, it may be challenging to speak and swallow. 
• Spasmodic dystonia: This type of dystonia impacts the muscle that enables speaking. 
• Tardive dystonia: This type occurs due to a reaction to any medication. Typically, the symptoms are temporary and are curable with treatment. 
• Paroxysmal dystonia: This kind of dystonia occurs only during specific episodes. The individual remains normal the rest of the time. 
• Torsion dystonia: This is an extremely unusual condition where an individual is severely disabled and is affected throughout their entire body. Symptoms typically start in childhood and worsen with age. Research shows that torsion dystonia may be inherited and brought on by a DYT1 gene mutation.  
• Writer’s cramp: Dystonia specific to writing is known as writer’s cramp. The hand or forearm muscles are significantly affected. 

When to visit a doctor? 

Early dystonia symptoms are frequently sporadic, minor, and associated with a particular activity. If you experience involuntary muscle contractions, consult the healthcare provider.  

Request an appointment at Apollo Hospitals     

What are the complications of dystonia? 

The following complications may occur depending on the type of dystonia: 

• Physical limitations that interfere with the patient’s ability to do certain chores or daily activities 
• Pain and exhaustion due to continual contraction of muscles
• Depression, anxiety, and isolation from society 
• Vision issues that can have an impact on the eyelids 
• Difficulty chewing, swallowing or speaking

What are the treatment options for dystonia? 

Treatment options for dystonia are numerous, and based on the nature and severity of the dystonia, the doctor may choose the appropriate course of treatment. 

Botulinum toxin, popularly known as Botox, is a modern medication. The affected muscle receives an injection of the drug to block the acetylcholine molecule, which causes muscular contractions. Every three months, the injection is administered. 

Deep brain stimulation is an alternative for people who have dystonia and are disabled. During deep brain stimulation, an electrode is inserted into a particular section of the brain. A battery-powered stimulator implanted in the chest is then attached to the electrode. To stop muscular contractions, the electrode sends electrical pulses generated by the stimulator to the critical brain area. 

Medication can also lessen the signals that lead to dystonia’s excessive muscular contractions. The symptoms of dystonia may also be managed by stress reduction, physical treatment, and speech therapy. 

Another choice of treatment is a sensory trick. The muscles may contract less forcefully by applying stimulation to the affected or neighbouring body region. The patients can control their own contractions by simply touching those spots. Applying heat or cold in those spots may also help relieve muscle pain. 

Conclusion

Living with dystonia is not easy. The body won’t let the patient move as freely as they used to or do  chores like other people. This creates a frustrating situation, and the family and friends of the patient need to be empathetic and supportive of the patient. It is vital to check the underlying cause and seek the proper treatment and coping mechanisms for a better quality of life. 

Frequently Asked Questions (FAQs) 

What are the alternative treatment methods for dystonia? 

Research is still going on to prove the effectiveness of alternative treatments for dystonia. But yoga, meditation, breathing technique and others may help relieve tension and pain in the body. 

Does therapy help manage dystonia? 

Physical therapy, occupational therapy, speech therapy etc., can help ease the symptoms of dystonia.  

What tests help in diagnosing dystonia? 

To diagnose dystonia, the healthcare provider may prescribe  blood tests, urine tests, MRI/CT scan, electromyography test or gene testing to determine the cause.