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Dystonia

Offering a Full-Range of Dystonia Treatment and Therapies

The Department of Neurosurgery at Rutgers Health and RWJBarnabas Health treats movement disorders such as dystonia through a multidisciplinary team approach. Our board-certified neurologists, neurosurgeons and support staff offer dystonia treatment focusing on symptom relief. This chronic, often progressive disorder is not life-threatening, but can cause significant disability. To address a patient’s physical and psychological health, patients may also be seen by physical therapists, speech pathologists, and psychotherapists. Our goal is to provide a long-term treatment solution, so patients can lead more fulfilling lives with improved function. While there is no cure for this disorder, the latest research indicates that dystonia patients often respond well to deep brain stimulation.

What Is Dystonia?

Dystonia is a neurological disorder affecting movement and has many different classifications. Overall, dystonia is characterized by uncontrollable, repetitive muscle contractions and spasms. Also called a movement disorder, individuals with dystonia may have a rigid, distorted posture and have trouble walking or living independently. Abnormal movements may be described as twisting, jerky, or cramped. Some patients have difficulty speaking.

Areas of the body often affected include the neck, eyelids, jaw and/or tongue, vocal cords, and forearms and/or hands. Early signs of dystonia are often subtle, including trembling hands, voice problems, rapid blinking, involuntary twitching, and so on.

Dystonia Classifications and Their Symptoms

Dystonic movement disorders are classified in several ways, including the cause (primary or secondary), the part(s) of the body affected, and the age of onset. Usually, dystonia symptoms begin subtly and get gradually worse and more noticeable over time.

Symptoms vary depending on the area(s) of the body affected, which may include:

  • Neck: Called cervical dystonia, those with dystonic movements of the neck will turn and twist their head to one side.

  • Eyelids: Rapid, involuntary blinking is a common symptom, called blepharospasms.

  • Jaw or tongue: Patients with oromandibular dystonia may drool, have slurred speech, and experience difficulty chewing or swallowing.

  • Voice box and vocal cords: This can cause a tight, whispering voice.

  • Hand and forearm: Writer’s cramp or musician’s cramp are common dystonic symptoms causing pain and rigidity in the hand and/or forearm muscles.

Common types of dystonia include:

  • Generalized: Occurs throughout extensive areas of the body, although some individuals are affected more than others.

  • Focal: Patients have dystonic movement in an isolated part of the body, such as the hand cramping.

  • Multifocal: Patients with dystonic movements in two, non-contiguous areas of the body.

  • Segmental: Occurs in two connected areas, such as the eyes and mouth.

  • Hemidystonia: Only one side of the body is affected.

What Causes Dystonia?

  • Idiopathic: Most cases of dystonia have no known cause and are called “idiopathic.”

  • Genetic: Dystonic movement may be a symptom of another disease or condition. Many other neurological conditions feature dystonic symptoms, including Parkinson’s, Huntington’s and Wilson’s diseases.

  • Acquired: Dystonia may be acquired as a result of a traumatic brain injury, stroke, brain tumor, oxygen deprivation, carbon monoxide poisoning, infections, or reactions to heavy metal poisoning.

Dystonia Diagnosis

As with any neurological condition, your physician will conduct a thorough physical examination and take a medical history. Usually, dystonia does not require testing, only a physical examination and observation. However, further testing may be useful to uncover another underlying condition which could be responsible for dystonia symptoms.

Unfortunately, many dystonia patients are initially misdiagnosed, because the condition may have only subtle symptoms at first, while other patients may have a very unusual manifestation. Symptoms of dystonia may be misdiagnosed as an orthopedic condition, muscle cramps/contractures, an essential tremor, or tics.

Dystonia Treatment

Although there is currently no cure, there are many treatment options to manage dystonia symptoms of muscle spasms, pain, involuntary movements, and rigid posture. Every patient’s case of dystonia is unique, and so is each course of treatment. Our neurologists and neurosurgeons customize treatment to each individual patient to manage the symptoms, and they may recommend a combination of treatments. Medication, therapies, and surgery may be indicated for patients, depending on the degree of disability.

Medication

Numerous oral and injectable medications may improve dystonic symptoms by targeting the chemicals in the brain affecting muscle movement. Options include:

  • Anticholinergics: These medications block the acetylcholine neurotransmitter, which helps activate muscle movement.

  • Benzodiazepines and baclofen: These drugs are commonly used as an anti-anxiety treatment. They act on the GABA-A and -B neurotransmitters and may help some forms of dystonia.

  • Dopaminergic Agents: This medication can increase dopamine neurotransmitter levels, or block dopamine.

  • Botox injections: Short for “botulinum neurotoxin,” Botox injections are a localized treatment injected into muscles to reduce involuntary muscle movements. They are most effective for patients suffering from focal (isolated) dystonia.

Deep Brain Stimulation

This neurosurgical procedure involves the implantation of electrodes in the brain to treat dystonia and other movement disorders. Similar to a pacemaker used for the heart, this “brain pacemaker” delivers electrical stimulation to areas of the brain responsible for dystonia symptoms. While the exact mechanism of action is still not fully understood, deep brain stimulation (DBS) effectively interrupts abnormal brain activity responsible for involuntary body movements by weakening the excessive signals sent to the muscles. Although DBS is not a standalone treatment, it can significantly improve quality of life and resolve many dystonia symptoms.

Request an appointment online now or call 833-656-3876.