Dystonia

Dystonia is a neurological movement disorder. If you have it, your muscles spasm and contract without you meaning them to.

The movements often repeat, and they pull the body into unusual, awkward and sometimes painful postures. Some types of dystonia also bring tremor (shaking).

Dystonia can be a condition in its own right, and this is called primary dystonia. In other people it appears as a symptom of another condition, which is called secondary dystonia.

Dystonia can cause several different symptoms, including:

• uncontrolled muscle spasms
• parts of your body twisting into unusual positions, like your neck being pulled to the side or your feet turning inwards
• shaking (tremors)
• excessive blinking

The symptoms may be continuous, or they may come and go. Voluntary movements can sometimes trigger them.

Generalised dystonia is the form of dystonia that affects all parts of the body.

With focal dystonia, only one muscle group is affected.

The most common type is neck dystonia, also known as cervical dystonia. It usually pulls the head in one direction, and that can affect your movement and cause pain.

Other types of focal dystonia can affect:

• your voice (laryngeal dystonia)
• the muscles around your eyes (blepharospasm)
• limbs (like writer's cramp)

Doctors think dystonia is caused by a problem in the part of the brain that controls movement. The causes may not be the same in primary and secondary dystonia.

Primary dystonia often starts in childhood. It's also the type more likely to have a recognised genetic cause.

Dystonia can sometimes show up as a symptom of another condition. When that happens, it's called secondary dystonia. It might be caused by:

• Parkinson's disease
• cerebral palsy
• certain medicines (like some antipsychotics and some anti sickness medicines)
• injury to the brain
• stroke

If your doctor thinks you have dystonia, they may send you to a neurologist, a specialist in conditions of the nervous system. You may then need some tests to find out whether you have primary or secondary dystonia. Depending on your symptoms, this could be a blood test or a scan.

Dystonia can cause involuntary movements and spasms, and there are treatments that can control them. You may need to try several options before you find the one that works best for you.

If you have focal dystonia, your doctor might offer you botulinum toxin. It's injected into the affected muscles. The toxin blocks the neurotransmitters within the nerve, and this reduces the muscle spasms.

The effects of an injection can last from around 3 months to 6 months.

Tablets and other oral medicines can work well for some people with generalised dystonia. Doctors may use several kinds of medicine to treat dystonia, including:

• anticholinergics
• baclofen
• muscle relaxants

Depending on the type of dystonia you have, physiotherapy might help you move more freely and improve your range of movement.

Surgery is an option if your dystonia symptoms don't get better with other treatments.

Deep brain stimulation (DBS) is a type of brain surgery. Some people with dystonia are offered it when other treatments haven't worked.

The surgeon places a small device, like a pacemaker, under the skin of your chest or tummy. This device sends electrical signals along wires placed in the part of the brain that controls movement.

You won't feel the benefit of DBS straight away. It'll be several weeks or months before you begin to notice it.