What is Dystonia:
Dystonia is a neurological disorder in which the whole body or a body part goes in to abnormal twisted posture. There may at sometimes be some jerky movements or tremulous movement associated with these abnormal postures.
What happens in Dystonia:
Dystonia is caused by continuous or intermittent simultaneous contractions of muscles, which act in opposite manner or similar manner.
What is the cause of Dystonia
The actual case of Dystonia is imbalance of chemicals in that part of brain, which regulates movements. It can be cased by
a) Genetic factors
d) Injury to brain
e) Brain injury due to impaired blood supply at the time of birth
f) Vascular cause: when there is a small stroke affecting the special part of brain (basal ganglion) which controls movements
What is the basis of Dystonia:
As Dystonia is disease of brain, it is caused by some problem in brain. In majority of cases there are cause of dystonia such as tumors, lack of blood supply, infection or bleeding, and in those cases it is caused by imbalance of chemicals in the brain, which may be caused by some unknown factors. Genetic factors play a role in a large majority of cases. In rare cases it may be caused by a tumor, infection or stroke.
What are the types of Dystonia:
Dystonias are of different types. Please see below:
1) There are some dystonias, which involve the whole body (generalized dystonia).
2) There are some dystonias which involve a single part of body (these are focal Dystonias) or two contiguous parts of body (segmental dystonia) or several distant parts of body (multi- focal dystonia) or whole body (generalized Dystonia).
3) There are some dystonia for which a cause is known in others cause is not known. Hence we draw two groups such as:
3a) Primary dystonia (dystonia with no cause)
In this category genetic factor are involved which may be apparent or not. These genetic factors result in imbalance of chemicals.
3b) Symptomatic dystonia (in this dystonia occurs due to another factor which is known. For example dystonia can occur due to:
· Wilson’s disease
· Huntington disease
· Some metabolic disease like, hypo-parathyroidism or hyper-parathyroidism etc.
· Or it can happen when there is lack of blood supply, oxygen supply or bleeding in a focal part of brain.
To understand this, I will try it with a simplified diagram of brain.
We know that right side of brain controls left side of body and left side of brain controls right side of body. So if there is any disease or a tumor, infarction or an infective abscess on left lentiform nucleus/caudate nucleus, we can have dystonia on right side of body. But these causes are very few.
2A) Focal Dystonia:
These are those dystonias which involve a localized part of body. Most often focal dystonia do not have a cause and are generally genetic in nature.
Following are the types of focal dystonia:
i) Cranial Dystonia (these involve head region).
For example, it can involve only eyelids
(blepharo-spasm), jaw only (oro-mandibular-
dystonia), tongue only (lingual dystonia ),
Speaking (spasmodic dysphonia). Sometimes
they can occur in combination like eyes, jaws
and tongue (Merge’s syndrome-derived from
the name of the patient who was first
identified to have it).
ii) Neck (Cervical dystonia or spasmodic torticollis):
In this type the neck goes backwards (retrocollis),
forwards (antecollis) is shifted side wards(latero
collis) or the neck is rotated either right side or left side (spasmodic torticollis).
iii) Arm usually dystonia involving arm or upper limb occurs while doing some activity like writing, using key board, playing musical instruments: violin, sitar, or golf or tennis.
In that case it is called as Task Specific Dystonia or writer’s cramp, musician cramp, golfer’s camp, tennis player’s cramp, etc.
iv) Leg (Crural Dystonia): these involve the legs. They are very rare. In children dystonia, which starts in legs usually, spreads to involve the whole body. In adults leg dystonia is usually secondary to a known cause (secondary) dystonia eg. Parkinson’s disease, head injury etc.
2B) Segmented Dystonia
Segmented dystonia is the term used when 2 contiguous body parts are involved in dystonia. Examples are:
· Dystonia of neck and arm.
· Oromandibular along with cervical dystonia.
· Face along with neck etc.
What is the treatment of Dystonia:
Treatment of Dystonia can be done by different methods:
3) Yoga and Meditation
4) Non conventional methods
1) Medicines or drugs: These are some drugs, which are used in the treatment of dystonia. Before we start treatment of dystonia, we must know what is the cause of dystonia. Sometimes the cause of dystonia can be treated. In that case, it is the best thing to do. For example if dystonia is due to Wilson’s Disease, tumor or any metabolic cause like calcium deposition in brain due to hormonal defect, specific treatment is most y effective strategy in the treatment of dystonia. Talking about medicines; younger people and children tolerate high doses of medicines and sometimes the response is better. All these medicines are associated with side effects, which we must not ignore or forget.
2) Surgical treatment (operations):
Different types of operations can be done. In some operations a part of the brain is destroyed, or the nerves going to that part is blocked. In addition Deep Brain Stimulation (DBS) of a part of the brain called Globus Pallidus is beneficial in some cases. In DBS the stimulation is done by a battery similar to a pacemaker, implanted in the chest just like the pacemaker for patients with heart problems.In another surgery baclofen pump is placed in the abdominal wall and a drug called baclofen is slowly delivered (sent) to the fluid surrounding the spinal cord and brain through a small catheter (tube).
3) Yoga and Meditation:
We all have seen that dystonia becomes more severe when we are anxious. Hence regular practice of relaxing yoga and meditation is helpful in all people. These can be done along with medicines and even before and after operation.
4) Non-conventional treatment:
Some people try acu-puncture, reflexology in the treatment. The effect is not tested in scientific way but one can try it.
Hope the information given in this brochure was useful.
Please give your feedback and anything more you wish to know, please contact the author:
Dr. Madhuri Behari
Fl. Lt. Rajan Dhall Fortis Hospital
Vasant Kunj, New Delhi