Although there is no specific cure for dystonia, treatments focus on managing muscle contractions and the parts of the body that are being affected. Treatment options include medications, physical therapy, surgery or some combination of the three.
The cause of dystonia is not completely understood. However, it may involve a problem with nerve-cell communication in specific areas of the brain. Some forms of dystonia are inherited, but it can also be a symptom of another disease or condition, such as:
- Parkinson’s disease
- Huntington’s disease
- Wilson’s disease
- Brain tumor
- Infection (tuberculosis or encephalitis)
- Oxygen deprivation
- Carbon monoxide poisoning
- Reaction to medications or heavy metal poisoning
The most common dystonia medical treatment is medications that reduce the intensity of the overactive muscle groups. These include anticholinergic medications like trihexyphenidyl, benzodiazepines (such as Clonazepam) and muscle relaxants like Baclofen.
If you are living with a focal dystonia involving a single muscle or isolated muscle group, botulinum toxin (Botox) can be injected into the overactive muscles. This generally needs to be repeated every three to four months. Physical therapy can also be beneficial in easing symptoms of dystonia, whereas speech therapy is helpful if laryngeal dystonia is affecting your voice.
If you suffer from a more debilitating case of dystonia, especially generalized dystonia, surgery may be an option. A Baclofen pump can be inserted into your spine if you suffer from severe lower extremity dystonia. If you’ve been diagnosed with generalized dystonia or upper body dystonia that doesn’t respond well to medications, deep brain stimulation (DBS) is a treatment option. In deep brain stimulation surgery, electrodes are implanted in your brain and connected to a device (similar to a pacemaker) that emits electrical impulses to your brain to lessen and manage muscle contractions.
The Movement Disorders Center of the Northwell Health Neuroscience Institute improves lives by providing the most up to date and advanced treatments for a wide range of neurological movement disorders and diseases, including dystonia.
After an extensive assessment by the Movement Disorders Center team, your doctor will discuss treatment options with you. Accurate diagnosis for dystonia is crucial since there can be symptoms that mimic other conditions. At the Movement Disorders Center, we take a collaborative approach to diagnosis and treatment.
There are multiple types of dystonia affecting many different parts of the body. These can be broken down into three groups:
- Idiopathic – with no known cause
- Genetic – caused by hereditary factors
- Acquired – the result of some form of damage to the brain (lack of oxygen, infection, stroke or trauma)
Dystonia is often categorized based on the part of the body it affecta, such as:
- General dystonia – affecting most of or the entire body, especially the back and trunk
- Multifocal dystonia – involving two or more unrelated body parts
- Segmental dystonia – affecting a specific muscle group
- Focal dystonia –focused or localized to one part of the body
There are multiple types of focal dystonia, including:
- Blepharospasm – affecting the eyes, causing involuntary winking
- Laryngeal dystonia –affecting the voice and vocal cords
- Oromandibular dystonia (OMD) – affecting the face, jaw and voice
- Lingual dystonia – affecting the tongue
- Cervical dystonia – affecting the neck and upper shoulders
- Lower limb dystonia – affecting the leg, foot, toes
- Hand dystonia –affecting the hand, finders, wrist or forearm, often referred to as “writer’s cramp”
Side effects associated with medications to treat dystonia vary. Anticholinergic medications like trihexyphenidyl and benzodiazepines can have a sedating effect and may cause memory loss or fogginess depending on the dosage, particularly in elderly patients. Other common side effects include dry mouth and constipation. Botulinum toxin side effects are mild and can cause dry mouth and weakness of the neck. Surgery presents its own set of side effects, which may include bleeding, risk of infection, fever and possible swelling. Post-surgery swelling and general discomfort should improve rapidly.
There is generally no treatment preparation required for physical therapy or medication therapy, although certain medications will come with specific instructions. Treatment preparation for surgery will depend on the surgical procedure recommended by your doctor.
Dystonia is a chronic disorder, and symptoms can be unpredictable and may alter over time. Prognosis for this condition varies depending on the type and severity of your dystonia. If you are taking medication you will need to consult with your doctor on a regular basis. Treatments, such as botulinum toxin, can go on indefinitely. In the case of surgery, deep brain stimulation can provide some relief from involuntary movements and abnormal postures associated with the condition, but is not considered a cure.