Dystonia is an involuntary movement disorder where muscles are inappropriately overactive, leading to abnormal postures and twisting movements.
Dystonia may affect any muscle in the body, but tends to occur in specific sites. Involvement of the eyelids leading to excessive blinking or sustained eye closure is known as blepharospasm. The neck muscles may be involved, leading to involuntary rotation of the neck, tilting to one side or pulling forwards or backwards, known as cervical dystonia or torticollis. Dystonia may also affect the fingers or the hand while performing certain tasks such as writing or playing an instrument. Writer’s and musician’s cramp are forms of dystonia localized to the hand. An unusual aspect of dystonia is that it may only occur while performing certain activities such as typing or writing whereas other activities are performed without any problems at all.
Medications are available that can calm muscle overactivity in dystonia and include benzodiazepines such as Klonopin or Valium, or anticholinergics such as Artane. However, the dose of medication that is necessary to control symptoms often can lead to concurrent side effects of oversedation or problems with thinking.
Botulinum toxin injections are highly effective in controlling symptoms of dystonia that are localized. As injections only target muscles involved in the abnormal movements, there are no adverse side effects on the brain. Botulinum toxin injections are given every 3-4 months on average for dystonia due to the return of symptoms. The side effects of therapy can include weakness of the injected muscle or temporary difficulty with swallowing. An ultrasound machine or an electromyogram machine may be used to help locate muscles for precise injections.
In some cases, dystonia can be more widespread and affect multiple body parts or muscle groups, severely affecting movement of the hands or legs or impairing walking. These cases may be amenable to surgical therapy with deep brain stimulation (DBS).
Dystonia Patient Resources
Dystonia Medical Research Foundation - https://www.dystonia-foundation.org
The Bachmann-Strauss Dystonia & Parkinson Foundation - http://www.dystonia-parkinsons.org