Dystonia is a neurological disorder that is characterized by sustained and involuntary contractions of opposing muscles that result in twisting movements or abnormal postures. It may affect any body part: Neck, eyes, hands, arms, legs, trunk, face or jaw. While some patients may have mild symptoms, others might present disabling symptoms that result form the twisted postures or as a result of the severe pain.
Fifteen years ago, therapeutic options were quite limited and consisted of medication that despite their effectiveness, were associated with side effects that limited their use. The story nowadays is different, as the introduction of botulinum toxins and surgical options to treat this disorders offer hope to most patients suffering form this conditions.
The manifestations of dystonia are quite variable. The classification is based on the etiology or body parts affected. The etiology refers to the particular cause of the disorder. Most patients have idiopathic dystonia, meaning the cause is unknown. However, other have secondary dystonias, as they are a result of genetic mutations, trauma, certain medications, etc.
The classification by body part involved is outlined as follows:
- Focal Dystonia– affects a single body part or location (i.e. the eyes in blepharospasms; the neck in cervical dystonia; one hand in writer’s cramp)
- Segmental Dystonia – affecting adjacent body parts (i.e. one neck and an arm, the trunk and the leg etc.)
- Hemidystonia – affecting one side of the body (i.e. whole left side of the body)
- Generalized – affecting more than 2 segments of the body
How Prevalent is Dystonia?
When we speak about the prevalence of dystonia, the first things to realize is that some dystonias are more common than others. The incidence of generalized dystonias is 2 per million per year. The incidence of focal dystonia is 24 per million per year. The prevalence of generalized dystonia is 34 per million, and the prevalence for focal dystonia is 295 per million. Cervical dystonia is the most common focal dystonia, while the other dystonias have similar rates.
More categories of dystonia
- Blepharospasm or Meige’s Syndrome is a focal dystonia which causes severe blinking or screwing of the eyes along with involuntary facial movements. The condition can be quote disabling. Some patients experience severe muscle spasms, to the point that they are rendered “functionally” blind, as they can’t keep their eyes open for driving or performing other activities. These patients respond well to botulinum toxin therapy in most cases.
- Cervical Dystonia or Spasmodic Torticollis is a focal dystonia, causing neck spasms and muscle contractions in the neck area. This condition is well known to be associated with neck pain. Most patients respond to therapy with botulinum toxin, in both abnormal posture and pain.
- Tardive dystonia is a dystonia that results from exposure to antipsychotic agents. The dystonias can be painful, severe, and they are a challenge to treat. Certain medications might help, as well as botulinum toxin therapy. Your doctor can assess whether a therapeutic trial with these medications can help.
- Post-Traumatic dystonia is a dystonia that may occur after suffering trauma, usually to the affected body part. For example, some patients may develop foot dystonia after twisting or breaking their ankle or dystonia of their trunk after trauma. Some have developed cervical dystonia after sustaining whiplash injuries.
- Psychogenic dystonia affects only 1-5% of the population, and requires ongoing treatment by a specialist as well. Psychogenic dystonias are not “true dystonias”. They are usually a manifestation of stress or psychological problems. Despite the etiology being as described, a common misconception is that patients with this condition are making up or “faking” the symptoms purposefully. Most times the symptoms are involuntary, but the treatment options are different.
What can I do if I suffer from dystonia?
Your condition can be evaluated by one of our doctors and our interdisciplinary team and an opinion and treatment plan can be provided to improve the symptoms associated with the condition. For more information on how to book an appointment with our team, call 352-294-5400 or fill out this Appointment Form.