Dystonia

Date Updated: 04/25/2020

Overview

Dystonia is a movement disorder in which your muscles contract involuntarily, causing repetitive or twisting movements.

The condition can affect one part of your body (focal dystonia), two or more adjacent parts (segmental dystonia) or all parts of your body (general dystonia). The muscle spasms can range from mild to severe. They may be painful, and they can interfere with your performance of day-to-day tasks.

There's no cure for dystonia. But medications can improve symptoms. Surgery is sometimes used to disable or regulate nerves or certain brain regions in people with severe dystonia.

Symptoms

Dystonia affects different people in varying ways. Muscle contractions might:

Begin in a single area, such as your leg, neck or arm. Focal dystonia that begins after age 21 usually starts in the neck, arm or face and tends to remain focal or segmental.
Occur during a specific action, such as handwriting.
Worsen with stress, fatigue or anxiety.
Become more noticeable over time.

Areas of the body that can be affected include:

Neck (cervical dystonia). Contractions cause your head to twist and turn to one side, or pull forward or backward, sometimes causing pain.
Eyelids. Rapid blinking or involuntary spasms cause your eyes to close (blepharospasms) and make it difficult for you to see. Spasms usually aren't painful but might increase when you're in bright light, under stress or interacting with people. Your eyes might feel dry.
Jaw or tongue (oromandibular dystonia). You might experience slurred speech, drooling, and difficulty chewing or swallowing. Oromandibular dystonia can be painful and often occurs in combination with cervical dystonia or blepharospasms.
Voice box and vocal cords (spasmodic dystonia). You might have a tight or whispering voice.
Hand and forearm. Some types of dystonia occur only while you do a repetitive activity, such as writing (writer's dystonia) or playing a specific musical instrument (musician's dystonia).

When to see a doctor

Early signs of dystonia often are mild, occasional and linked to a specific activity. See your doctor if you're experiencing involuntary muscle contractions.

Causes

The exact cause of dystonia isn't known. But it might involve altered nerve-cell communication in several regions of the brain. Some forms of dystonia are inherited.

Dystonia also can be a symptom of another disease or condition, including:

Parkinson's disease
Huntington's disease
Wilson's disease
Traumatic brain injury
Birth injury
Stroke
Brain tumor or certain disorders that develop in some people with cancer (paraneoplastic syndromes)
Oxygen deprivation or carbon monoxide poisoning
Infections, such as tuberculosis or encephalitis
Reactions to certain medications or heavy metal poisoning

Complications

Depending on the type of dystonia, complications can include:

Physical disabilities that affect your performance of daily activities or specific tasks
Difficulty with vision that affects your eyelids
Difficulty with jaw movement, swallowing or speech
Pain and fatigue, due to constant contraction of your muscles
Depression, anxiety and social withdrawal

Diagnosis

To diagnose dystonia, your doctor will start with a medical history and physical examination.

To determine if underlying conditions are causing your symptoms, your doctor might recommend:

Blood or urine tests. These tests can reveal signs of toxins or of other conditions.
MRI or CT scan. These imaging tests can identify abnormalities in your brain, such as tumors, lesions or evidence of a stroke.
Electromyography (EMG). This test measures the electrical activity within muscles.
Genetic testing. Some forms of dystonia are associated with certain genes. Knowing whether these genes are present can help guide treatment.

Treatment

To manage your muscle contractions, your doctor might recommend a combination of medications, therapy or surgery.

Medications

Injections of botulinum toxin (Botox, Dysport, others) into specific muscles might reduce or eliminate your muscle contractions and improve your abnormal postures. Injections are usually repeated every three to four months.

Side effects are generally mild and temporary. They can include weakness, dry mouth or voice changes.

Other medications target chemicals in your brain (neurotransmitters) that affect muscle movement. The options include:

Carbidopa-levodopa (Duopa, Rytary, others). This medication can increase levels of the neurotransmitter dopamine.
Trihexyphenidyl and benztropine (Cogentin). These two medications act on neurotransmitters other than dopamine. Side effects can include memory loss, blurred vision, drowsiness, dry mouth and constipation.
Tetrabenazine (Xenazine) and deutetrabenazine (Austedo). These two medications block dopamine. Side effects can include sedation, nervousness, depression or insomnia.
Diazepam (Valium), clonazepam (Klonopin) and baclofen (Lioresal, Gablofen). These medications reduce neurotransmission and might help some forms of dystonia. They may cause side effects, such as drowsiness.

Therapy

Your doctor might suggest:

Physical therapy or occupational therapy or both to help ease symptoms and improve function
Speech therapy if dystonia affects your voice
Stretching or massage to ease muscle pain

Surgery

If your symptoms are severe, your doctor might recommend:

Deep brain stimulation. Electrodes are surgically implanted into a specific part of your brain and connected to a generator implanted in your chest. The generator sends electrical pulses to your brain that might help control your muscle contractions. The settings on the generator can be adjusted to treat your specific condition.
Selective denervation surgery. This procedure, which involves cutting the nerves that control muscle spasms, might be an option to treat some types of dystonia that haven't been successfully treated using other therapies.

Lifestyle and home remedies

Dystonia has no cure, but you can do a number of things to minimize its effects:

Sensory tricks to reduce spasms. Touching certain parts of your body may cause spasms to stop temporarily.
Heat or cold. Applying heat or cold can help ease muscle pain.
Stress management. Learn effective coping skills to manage stress, such as deep breathing, social support and positive self-talk.

Alternative medicine

Alternative treatments for dystonia haven't been well-studied. Ask your doctor about complementary treatments before you start. Consider:

Meditation and deep breathing. Both might ease stress that can worsen spasms.
Biofeedback. A therapist uses electronic devices to monitor your body's functions, such as muscle tension, heart rate and blood pressure. You then learn how to control your body responses, which might help reduce muscle tension and stress.
Yoga. Yoga combines physical postures, breathing techniques, and meditation or relaxation.

Coping and support

Living with dystonia can be difficult and frustrating. Your body might not always move as you would like, and you may be uncomfortable in social situations. You and your family might find it helpful to talk to a therapist or join a support group.

Preparing for an appointment

You may be referred to a doctor who specializes in disorders of the nervous system (neurologist).

What you can do

Write down your symptoms, including any that may seem unrelated to the reason why you scheduled the appointment.
Make a list of all your medications, vitamins and supplements.
Write down your key medical information, including other conditions.
Write down key personal information, including any recent changes or stressors in your life.
Write down questions to ask your doctor.
Ask a relative or friend to accompany you, to help you remember what the doctor says.

Questions to ask your doctor

What's the most likely cause of my symptoms?
What kinds of tests do I need? Do they require any special preparation?
Is my condition likely temporary or chronic?
What treatments are available?
What side effects can I expect from these treatments?
I have these other health conditions. How can I best manage them together?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may make time to go over points you want to spend more time on. You may be asked:

When did you first notice your symptoms?
Have your symptoms been continuous or occasional?
How severe are your symptoms?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?
Has anyone in your family ever been diagnosed with dystonia?