• Focal Dystonia

    Definition

    Focal dystonia is an irregular movement disorder specific to one part of the body. In dystonia, muscle contractions cause irregular movements, twitches, tics, and twisted or repetitive postures. These may be continuous or off and on. The most common types of focal dystonia are:
    • Blepharospasm—an eye twitch
    • Cervical dystonia or spasmodic torticollis—affecting the neck
    • Segmental cranial dystonia, also known as Meige syndrome—affecting the jaw, tongue and eyes
    • Oromandibular dystonia—affecting the jaw
    • Spasmodic dysphonia—affecting the vocal cords
    • Axial dystonia—affecting the trunk
    • Dystonia of the hand/arm, such as writer's cramp
    Focal dystonia can be treated. If you suspect you have this condition, contact your doctor.

    Causes

    Dystonias are caused by flaws of the basal ganglia of the brain. This is where messages that begin muscle contractions are processed. Factors that may cause focal dystonia include:
    The Process of Carbon Monoxide Poisoning Decreasing Available Oxygen
    Carbon monoxide poisoning
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    Risk Factors

    Factors that can increase your risk of developing focal dystonia include:
    • Family history of dystonia
    • Recent exposure to an antinausea or antipsychotic medicine

    Symptoms

    If you have any of these symptoms, do not assume it is due to focal dystonia. These symptoms may be caused by other conditions:
    • Eyelid spasms
    • Rapid or uncontrollable blinking of both eyes
    • Neck twisting
    • Difficulty writing
    • Foot cramps
    • Pulling or dragging of a foot
    • Tremor
    • Voice or speech difficulties
    Factors that may worsen dystonia include:
    • Excitement or agitation
    • Stress
    • Talking
    • Fatigue

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may be referred to a speech-language pathologist, physical or occupational therapists, and/or genetic counselors.
    Tests may include:
      Your bodily fluids and tissue may need to be tested. This can be done with: The electrical activity of your muscles, nerves, and brain may need to be measured. This can be done with: Pictures may need to be taken of your head. This can be done with: Other exams may include:
      • Neurologic evaluation—to rule out other neurological disorders
      • Eye exam
    Electroencephalography
    EEG
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    Treatment

    Talk with your doctor about the best treatment plan for you. Treatment options include the following:

    Medications

    Certain medicines may help correct imbalances in neurotransmitters. Medicines used to treat dystonia include:
    • Trihexyphenidyl
    • Benztropine
    • Procyclidine HCl
    • Muscle relaxants
    • Levodopa and carbidopa
    • Bromocriptine
    Anticonvulsant medicines may also help people with dystonia. Your doctor will balance treating your symptoms with reducing the risk of side effects from the medicines.

    Botulinum Toxin Injections

    Injecting botulinum toxin directly into the muscles affected by dystonia can weaken the muscle. This may help improve symptoms for 3-4 months.

    Surgery

    Surgery to cut the nerves leading to muscles affected by dystonia or removing the muscles may help reduce muscle contractions. In addition, surgery to destroy the small area within the brain that dystonia occurs from may stop or reduce the disorder. More recently, some success has been reported using surgically implanted deep brain stimulation to reduce symptoms of dystonia.

    Prevention

    There is no known way of preventing focal dystonia. To help reduce your chances of getting this condition, take steps to reduce your risk of infection, stroke, trauma, and carbon monoxide or heavy metal poisoning. In addition, if you take any of the following medicines, talk with your doctor about your risk of developing dystonia as a side effect:
    • Levodopa
    • Bromocriptine
    • Antipsychotics
    • Metoclopramide
    • Dilantin
    • Calcium channel blockers
    • Selective serotonin reuptake inhibitors
    • Ergotamines
    • Antihistamines

    RESOURCES

    Dystonia Medical Research Foundation http://www.dystonia-foundation.org

    Worldwide Education and Awareness for Movement Disorders http://www.wemove.org

    CANADIAN RESOURCES

    Canadian Movement Disorder Group http://www.cmdg.org

    Health Canada http://www.hc-sc.gc.ca

    References

    Cervical dystonia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated August 29, 2012. Accessed February 25, 2013.

    Dystonia. The Canadian Movement Disorder Group website. Available at: http://www.cmdg.org/Movement%5F/dystonia/dystonia.htm . Accessed February 25, 2013.

    Gaenslen A. Transcranial sonography in dystonia. Int Rev Neurobiol . 2010;90:179-87.

    Meige Syndrome. National Organization for Rare Disorders. Available at: http://www.rarediseases.org/search/rdbdetail%5Fabstract.html?disname=Meige%20Syndrome . Accessed February 25, 2013.

    NINDS dystonias information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/dystonias/dystonias.htm . Updated February 21, 2013. Accessed February 25, 2013.

    Overview of dystonia. Worldwide Education and Awareness for Movement Disorders website. Available at: http://www.wemove.org/dys/dys.html . Updated January 14, 2011. Accessed February 25, 2013.

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