Dystonia

A Houston Methodist dystonia expert will conduct a thorough consultation to understand your symptoms. We will discuss your personal and family history, including whether you have had a previous head injury, stroke other neurological diagnosis or exposure to toxins or drugs. 

Then, we will perform a physical and neurological examination to determine whether your condition is primary or secondary dystonia. Other factors we will investigate include:

• Your age at symptom onset
• How many muscle groups are affected
• Whether affected muscle groups are connected
• Whether the cause might be genetic, environmental or unknown

If your exams indicate you have dystonia, we will narrow down the type to determine the best treatment:

• Primary dystonia, if this the only neurological disorder you have. Primary dystonia may be genetic (cervical dystonia, myoclonus and some forms of parkinsonism) or idiopathic (with no clear cause). 
• Secondary or acquired dystonia, which can be caused by exposure to certain medications, toxins, infections or stroke, as well as head or spinal cord injuries.

Dystonia may be classified by the number of muscle groups it affects:

• Focal dystonia is limited to one area of the body.
• Segmental dystonia affects two or more connected parts of the body (like head and neck). 
• Multifocal dystonia affects two or more non-connected parts of the body.
• General dystonia affects the entire body. 
  
   

Dystonia may also be sub-classified to the specific body areas or tasks it disrupts:

• Part of the body affected:
  • Muscles of the eyelids and brow (blepharospasm)
  • Neck or shoulders (cervical dystonia or spasmodic torticollis)
  • Face, jaw and/or tongue (oromandibular or cranial dystonia)
  • Vocal cords (spasmodic dysphonia or laryngeal dystonia)
  • Hand and/or forearm (hand dystonia or writer's cramp)
  • Foot and/or leg (lower limb dystonia)

• Tasks affected, such as the ability to play a musical instrument (musician’s dystonia)
• Early-onset twisting of the limbs and torso (a generalized dystonia with or without the presence of a certain gene DYT1 and non-DYT1)
• Caused by medications (tardive dystonia, a form of tardive dyskinesia)
• Psychological (psychogenic dystonia)
• Resemblance to other conditions or diseases:
  • Responding to the Parkinson’s disease (PD) medication Levodopa (dopa-responsive dystonia)
  • Hereditary dystonia with prominent myoclonus symptoms (myoclonus dystonia)
  • Episodic movement disorders in which abnormal movements occur only during attacks (paroxysmal dystonia and dyskinesia)
  • Hereditary dystonia with symptoms of PD that affect males much more often than females (X-linked dystonia-parkinsonism)
  • Hereditary dystonia with symptoms of PD (rapid-onset dystonia-parkinsonism)

Though there are currently no medications or procedures to cure dystonia, Houston Methodist provides the latest customized treatment options to reduce symptoms and improve your quality of life.

Your personalized care plan may include:

• Deep brain stimulation (DBS), which can help control movements. DBS involves surgically implanting small electrodes into the brain regions that control movement; the electrodes are connected to a pulse generator.
• Several classes of drugs affect various neurotransmitters, which can control dystonia symptoms in the short term.
• Botox® (Botulinum toxin) injections are an effective treatment for focal dystonia, which affect only one area of the body.
• Speech or voice therapy can help lessen spasmodic dysphonia, which affects the vocal cords.
• Physical therapy can help augment the neural pathways the brain uses to control movement.