Dystonia: Symptoms, causes, and types

Dystonia is a range of movement disorders that involve involuntary movements and extended muscle contractions. There may be twisting body movements, tremor, and unusual or awkward postures.

For some, the whole body may be involved in the movements, but for others, only certain parts of the body are affected. Sometimes, dystonia symptoms are linked to specific tasks, such as writing, as in writer’s cramp.

Fast facts on dystonia

Dystonia is not a single condition, but a range of disorders.

There are many causes of dystonia, including medications, oxygen deprivation, and Huntington’s disease.

Diagnosis will likely involve a range of tests and imaging techniques.

Treatment depends on the type of dystonia but might include medication, physical therapy, and surgery.

What is dystonia?

Neurons brain synapse
Dystonias are a group of neurological conditions.

Dystonia is a neurological condition, affecting the brain and nerves. However, it does not impact cognitive abilities (intelligence), memory, and communication skills.

It tends to be a progressive condition, but this is not always the case.

Dystonia may be inherited, and one gene that plays a role has been identified. However, other causes have been identified, for instance, taking certain medications. Some diseases, such as some forms of lung cancer, can also produce signs and symptoms of dystonia.

Treatment may include dopamine or sedative-type medications. Sometimes, surgery can help.

According to the American Association of Neurological Surgeons, dystonia affects up to 250,000 people in the United States. They suggest that it is the third most common movement disorder after essential tremor and Parkinson’s disease.

Although most cases of dystonia start in people aged 40 to 60 years, it can affect all age groups.

Symptoms

The symptoms of dystonia vary from mild to severe and can impact different parts of the body. The early symptoms include:

foot cramps

a “dragging leg”

uncontrollable blinking

difficulty speaking

involuntary pulling of the neck

Signs and symptoms vary depending on the type of dystonia they have. Below are some common examples:

Cervical dystonia

Cervical dystonia, also known as torticollis, is the most common form. It affects only one body part and generally starts later on in life. The neck muscles are affected most. Symptoms can include:

twisting of the head and neck

pulling forward of the head and neck

pulling backward of the head and neck

pulling sideways of the head and neck

Cervical dystonia can produce mild to severe symptoms. If muscle spasms and contractions are frequent and severe enough, the individual may also experience stiffness and pain.

Blepharospasm

Muscles of the eye
Blepharospasm affects the musculature of the eye.

The muscles around the eyes are affected. Symptoms might include:

photophobia (sensitivity to light)

irritation in the eye(s)

excessive blinking, often uncontrollable

eyes close uncontrollably

People with severe symptoms may find it impossible to open their eyes for several minutes.

The majority of people with blepharospasm find that symptoms worsen as the day progresses.

Dopa-responsive dystonia

Dopa-responsive dystonia primarily affects the legs. Onset occurs from ages 5-30. This type of dystonia responds well to levodopa, a dopamine medication.

The most common symptom is a stiff, unusual walk, with the sole of the foot bent upwards. In some cases, the foot may turn outwards at the ankle.

Hemifacial spasm

The individual experiences spasms in the muscles on one side of the face. Symptoms may be more prominent when the individual is under mental stress or physically tired.

Laryngeal dystonia

The muscles in the voice box (larynx) spasm. People with laryngeal dystonia may sound very quiet and breathy when they speak, or strangled – depending on which way the muscle spasms (in or out).

Oromandibular dystonia

This type of dystonia affects the jaw and mouth muscles. The mouth can pull outwards and upwards.

Some individuals will only have symptoms when the muscles of the mouth and jaw are being used, while others may experience symptoms when the muscles are not in use. Some individuals may have dysphagia (problems swallowing).

Writer’s cramp

Writer’s cramp involves uncontrollable cramps and movements in the arm and wrist. This is a task-specific dystonia, because it affects people who do a lot of writing before symptoms appear.

Other task-specific dystonias

musician’s cramp

typist’s cramp

golfer’s cramp

Generalized dystonia

Generalized dystonia normally affects children at the beginning of puberty. Symptoms generally occur in one of the limbs and eventually spread to other parts of the body.

Symptoms include:

Muscle spasms.

An abnormal, twisted posture, due to contractions and spasms in the limbs and torso.

A limb (or foot) may turn inwards.

Parts of the body may suddenly jerk rapidly.

Paroxysmal dystonia

In this rare version of dystonia, muscle spasms and abnormal body movements only happen at specific moments.

A paroxysmal dystonia attack can look like epilepsy during a seizure (fit). However, the individual does not lose consciousness and will be aware of their surroundings, unlike epilepsy. An attack can last for just a few minutes, but in some cases, may persist for several hours. The following triggers may bring on an attack:

mental stress

tiredness (fatigue)

consuming alcoholic beverages

consuming coffee

a sudden movement

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Types

Dystonia can be classified according to its underlying cause:

Primary dystonia – not related to another condition. No cause can be identified.

Secondary dystonia – related to genetics, a neurological change, or an injury.

Dystonia is also defined according to the body part(s) affected:

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