Dystonia

Dystonia is a condition in which muscles contract involuntarily. This leads to repetitive or twisting movements.

There are three types of dystonia, focal dystonia - which affects one part of the body, segmental dystonia - affects two or more adjacent parts of the body and general dystonia which affects all the parts of the body.

The muscle spasms in dystonia can be mild or severe. They can also affect day-to-day activities of a person with this condition.

Although several treatments are available, there is currently no cure for dystonia. Treatments include medications and surgery.

Dystonia affects different people in different ways so the symptoms of it may be different. Muscle contractions tend to begin in a single area, such as the neck, leg or arm.

Spasms may begin during a specific action such as writing or tying shoe laces. These muscle contractions may worsen with stress and get worse as the condition progresses.

The areas of the body that are mostly affected by dystonia include the neck (cervical dystonia), eyelids, jaw or tongue (oromandibular dystonia), voice box and vocal cords (spasmodic dystonia), and forearm.

The exact cause of dystonia is not known. Dystonia might occur as a result of altered nerve-cell communication in several parts of the brain.

Some types of dystonia have can be passed down from parents to children. Dystonia can also occur as a symptom of other diseases, such as Parkinson's disease, Huntington's disease, and Wilson's disease.

Other conditions that can cause dystonia include traumatic brain injury, stroke, brain tumor, infections like tuberculosis and meningitis, oxygen deprivation or carbon monoxide poisoning and reactions to certain medications or heavy metal poisoning.

Apart from a physical examination and a medical history, the following tests can also be used to diagnose dystonia.

• Blood or urine tests - to reveal signs of toxins or other conditions
• MRI and CT scans - to identify abnormalities in the brain, such as tumors, lesions or evidence of stroke
• Electromyography (EMG) - to measure the electrical activity of muscles These tests are usually carried out to determine if dystonia is caused by other underlying conditions.

Although several treatments are available, there is currently no cure for dystonia. Treatments include medications and surgery.

A combination of medications, therapy or surgery may be required for the management of muscle contractions.

Medications include:

• Botulinum toxin (Botox)- which can be injected every three to four months into specific muscles to reduce or eliminate muscle contractions and improve abnormal posture.
• Carbidopa-levodopa (Parcopa, Sinemet)- a combination medication that increases the level of the neurotransmitter dopamine.
• Trihexyphenidyl, benztropine- anticholinergic drugs.
• Tetrabenazine (Xenazine)- a medication that blocks dopamine.
• Diazepam (Valium), clonazepam (Klonopin), baclofen (Lioresal)- reduce neurotransmission and might lead to the formation of some forms of dystonia.

In addition to medications, doctors may also recommend therapy including:

• physical therapy to help ease the symptoms
• speech therapy if speech is affected
• stretching or massage to ease muscle pain and sensory tricks that involve touching the affected part of the body, which might reduce muscle contractions

Surgery may be recommended in cases where symptoms fail to improve despite medications and therapy.

Surgical procedures include:

Deep brain stimulation- a technique in which electrodes are surgically implanted into a specific part of the brain and connected to a generator that is implanted in the chest.

The generator sends electrical impulses to the brain that might help to control muscle contractions. The settings on the generator can be adjusted depending on the type of dystonia.

Selective denervation surgery- a procedure in which nerves that control muscle spasms. This procedure is used to treat dystonias in which other therapies have proven to be ineffective.

Alternative remedies used for dystonia include:

• Meditation, yoga and deep breathing- which may ease stress which tends to worsen symptoms of dystonia.
• Stretching and massage to ease muscle pain.
• Biofeedback-a treatment in which electronic devices are used to monitor body functions, such as heart rate, blood pressure, and muscle tension.

The complications of dystonia include:

• Physical disabilities that affect daily activities.
• Functional blindness if dystonia affects the eyelids.
• Difficulty moving the jaw, swallowing or speaking.
• Pain and fatigue due to continuous muscle contractions.
• Depression, anxiety and social withdrawal.