Dystonia Treatment in Delhi, India

Dystonia is a neurological movement disorder that causes repetitive or twisting movements due to involuntary muscle contraction. It can affect any part of the body, and the muscle spasms range from mild to severe. The condition is painful and interferes with a person's performance and day-to-day tasks. A person may experience repetitive movement, uncontrollable twisting, abnormal positions, and postures. These contractions can affect any part of the body, including the legs, face, neck, arms, eyes, and vocal cords.

Dystonia can occur in young children and older adults. It is incurable, but treatment and medications can help to control and improve the symptoms.

Types of Dystonia

Dystonia is often classified by the body part it affects. They are:

• Focal dystonia: Focal dystonia affects only one specific part of the body. It can affect the eyes, jaw, mouth, vocal cords, arms, or legs. Less commonly, it can cause unusual stretching, twisting of the trunk, or writhing moments of the abdominal wall. It commonly affects people in their 40s and 50s and is referred to as adult-onset dystonia. Focal dystonia occurs more in women than men
• Multifocal dystonia: Multifocal dystonia affects more than one unrelated part of the body. It can cause spasms in different parts, such as the right arm and left leg
• Segmental dystonia: Segmental dystonia affects two or more adjacent/close body parts. It commonly affects the jaw, eyelids, mouth, and lower face.
• General dystonia: General dystonia affects the entire body. It often begins in the leg and neck and spreads to the other body parts. This type of dystopia often begins in early childhood or adolescence.
• Hemidystonia: This dystonia occurs on one side of the body and affects the arm and leg.

Alternatively, dystonia can also be differentiated and classified based on syndrome and patterns.

Dystonia Signs & Symptoms

Dystonia can affect people of any age. Dystonia causes muscle contractions; a person may experience symptoms due to muscle contractions such as:

• Pain in any part of the body, such as the neck, arm, or leg.
• Problems while performing a specific action, such as painting or writing.
• Pain that worsens with anxiety, stress or fatigue.
• Involuntary movement or pulling.
• Speech problems.
• Uncontrollable blinking.
• Shaking movements.

People may also experience exhaustion due to constant muscle contractions. 

The most common body parts affected by dystonia include:

• Eyelids: The condition may cause rapid blinking or involuntary spasms that may make it difficult for a person to see.
• Neck: The condition may cause contradictions that can make a person's head twist and turn to a side or pull forward and backward, causing pain.
• Hand and forearm: A person may experience repetitive movements in their hand and forearm while doing a specific activity.
• Vocal cords and voice box: The condition may cause a person to have a tight or whispering voice.
• Jaw or tongue: A person may experience drooling, difficulty chewing, swallowing, or slurred speech.

Causes of Dystonia

The exact cause of dystonia is unknown. But dystonia may be caused by:

• Altered neuro cell communication in a few regions of the brain.
• Family history of dystonia.
• Any injury caused during birth.
• Infections.
• Reaction to medications.
• Poisoning.
• Oxygen deprivation.
• Exposure to heavy metals.

Dystonia can be a symptom of many other diseases or conditions, such as:

• Stroke.
• Parkinson's disease
• Wilson's disease
• Huntington's disease
• Brain tumour
• Paraneoplastic syndrome
• Severe brain injury
• Drug reaction

Risk Factors of Dystonia

Environmental factors can trigger dystonia. Other factors that increase the risk of dystonia include:

• Gender: Women are more prone to dystonia than men.
• Family history: A person is at higher risk if they have a family history of dystonia.
• Medications: Few medications can cause side effects that may increase the risk for dystonia.
• Age: Dystonia can occur at any age, but people in their 40s and 50s are at higher risk.

Diagnosis of Dystonia

Dystonia can be diagnosed with a medical history, present symptoms, and physical examination. To determine the causes or underlying conditions for the symptoms, the doctor may recommend:

• Blood or urine test: Blood and urine tests are useful to identify the causes of dystonia.
• Imaging tests: MRI and CT scans can help to identify abnormalities in the brain and diagnose diseases or disorders such as tumours, stroke, or lesions,
• Genetic testing: If a person has a family history of dystonia, it can be inherited through genes. Genetic tests identify the presence of such genes.
• Electromyography: Electromyography test measures the electrical activity in the muscles while performing a task or making movements.

Treatments for Dystonia

To manage muscle contraction and reduce pain, the doctor may recommend medications, therapy, or, in severe cases, surgery.

• Medications

Medications can be given to reduce or prevent muscle contractions and improve muscle movement. Medications are given through injections and are repeated after 3 to 4 months.

• Therapy

A doctor may suggest therapies in combination with medications. Physiotherapy or occupational therapy to ease symptoms and improve the functionality of muscles. Stretching or massage to relieve pain. If dystonia affects the voice, the doctor may suggest speech therapy.

• Surgery

Selective denervation surgery: This procedure involves cutting the nerve that controls muscle spasms. It is conducted to reduce the normal contractions in the affected muscles. Few types of dystonia can be treated with this surgery when any other treatment is unsuccessful. 

Deep brain stimulation: In this procedure, a generator is implanted in the patient's chest and electrodes are surgically implanted into a particular part of the brain. The generator sends electrical pulses to the brain to control the muscle contractions. 

Complications of Dystonia

Mild dystonia may not cause any complications. However, moderate or severe dystonia can cause complications such as:

• Physical disability that may affect daily activity and tasks.
• Stress or anxiety
• Depression and social withdrawal.
• Difficulty with swallowing, jaw movements, or speech.
• Problems with vision due to affected eyelids.
• Frequent pain and fatigue

Prevention of Dystonia

Dystonia can be caused by multiple factors. It can be caused due to health conditions, brain damage, infections, and genetics. Due to such multiple causes, dystonia may not be prevented. If a person has a family history, genetic testing can help to reveal the person's risk of having dystonia soon.

Prognosis of Dystonia

People with dystonia may experience physical restrictions. If it begins in childhood, it may spread to other body parts and have long-term effects. The condition is incurable, but proper treatment and physiotherapy can help a person to function better.

When to see a doctor?

Early signs of dystonia are often linked to a specific activity. If a person experiences involuntary muscle contractions while performing daily activities, they must consult a dystonia doctor.

Review

Reviewed by Dr. Sanjay Saxena, Senior Director & HOD, Neurosciences, Neurology.