Dystonia

Movement disorder specialists at UT Southwestern Medical Center offer each patient with dystonia a personalized treatment plan – based on the patient’s symptoms – that minimizes those symptoms and maximizes quality of life.

UT Southwestern has more than 20 years of established expertise in evaluating and treating dystonia with a variety of medical and surgical treatments, as well as offering support services. 

What Is Dystonia?

Dystonia is the third most common movement disorder, characterized by muscles contracting excessively and involuntarily. It is not a neurodegenerative disorder like Parkinson’s disease or Huntington’s disease. However, like those conditions, dystonia arises from the same circuitry and region in the brain.

People with dystonia experience abnormal posture, in which part or all of the body might be bent in a contorted position, restricting movements. The muscle contractions can be painful, and some patients might also have a tremor or incoordination.

The five main types of dystonia are classified by the part of the body they affect:

• Generalized dystonia affects most or all of the body and frequently involves the back and trunk.
• Focal dystonia is localized to a specific part of the body, such as the hand or eyes. Cervical dystonia, blepharospasm (involuntary muscle spasms and contractions of the muscles around the eyes), laryngeal dystonia, and writer’s cramp are all examples of focal dystonia.
• Multifocal dystonia affects two or more regions of the body that are not connected to each other, such as the left arm and left leg.
• Segmental dystonia affects two or more adjacent parts of the body. Cranial dystonia (involuntary contractions of the muscles of the jaw and tongue) and blepharospasm are two examples of segmental dystonia.
• Hemidystonia affects one entire side of the body.

Dystonia can also be classified according to age at onset:

• Early-onset generalized dystonia involves patients who develop symptoms prior to age 30. It’s characterized by twisted limbs. The younger the patient is at onset, the higher the likelihood that the dystonia will spread to other areas.
• Adult-onset dystonia symptoms typically appear in patients between 40 and 60 years of age. In most cases, symptoms start in the upper body and generally don’t spread.

What Are the Symptoms of Dystonia?

Dystonia symptoms can start at any age but usually appear between the ages of 20 and 60 and most often between ages 30 and 50. Symptoms can be mild or severe, and they can interfere with a person’s ability to complete daily tasks. Dystonia can affect the whole body or certain parts of the body, and symptoms vary, depending on the type of dystonia the patient has.

The main symptoms of dystonia are:

• Abnormal posture
• Cramps
• Involuntary muscle contractions that result in slow, repetitive movements
• Twisting body movements

Symptoms might also include:

• Difficulty speaking
• Foot cramps
• Muscle tremors
• Rapid eye blinking or closing
• Turning or dragging of the foot
• Worsening of handwriting

Symptoms might become more noticeable when a person is tired or under stress.

How Is Dystonia Diagnosed?

Diagnosis is usually based on a clinical evaluation by a neurologist. The types of tests each patient needs can vary widely and might include any of the following:

• Physical examination
• Detailed medical history
• Blood or urine test
• Magnetic resonance imaging (MRI)
• Computed tomography (CT) scan
• Electromyography

Neurologists at UT Southwestern provide not only an accurate diagnosis but also options for treatment plans based on each patient’s diagnosis and goals. The Movement Disorders team maintains an ongoing relationship with each patient, monitoring progress and offering support at every step.

How Is Dystonia Treated?

Our specialty-trained physicians use the latest advances in medicine and technology to offer the best course of treatment for each patient diagnosed with dystonia. Individual treatment depends on the type of dystonia, the patient’s age, and how long the patient has had the condition.

Patients at UT Southwestern have access to a range of treatment options, from medication to surgical intervention.

Medication

The following drugs can provide relief from dystonia symptoms:

• Anticholinergics block a neurotransmitter called acetylcholine, which contributes to muscle spasms in some dystonia cases.
• Benzodiazepines act like muscle relaxants through the GABA system in the brain, which inhibits the transmission of nerve signals in the brain and spinal cord.
• Baclofen is a muscle relaxer that is commonly used to treat select cases of dystonia, such as dystonia following traumatic injury to the central nervous system.
• Carbidopa and levodopa can increase levels of the neurotransmitter dopamine. A reduced level of dopamine is one of the possible causes of dystonia. Levodopa is converted to dopamine in the brain, and carbidopa keeps levodopa from being broken down before it reaches the brain.

Botulinum Toxin Injection for Dystonia

UT Southwestern specializes in the use of botulinum toxin injections for a variety of dystonias, including focal dystonia and cervical dystonia. Botulinum toxin is injected into the affected muscles to help relax them. Results last for about three months, so injections are repeated at regular intervals to maintain ongoing benefits.

Surgery for Dystonia

UT Southwestern offers expertise in surgical treatments for dystonia, including:

• Baclofen pump surgery: A pump is placed under the skin of the abdomen, along with a small catheter that is inserted into the fluid around the spinal cord. The pump is programmed by a remote computerized device to deliver small doses of baclofen directly to the spinal fluid. This procedure is especially effective at targeting dystonia affecting the legs.
• Deep brain stimulation (DBS): During this procedure, a neurosurgeon implants electrodes into a specific part of the brain. The electrodes are connected to a generator implanted in the chest near the collarbone that sends electrical pulses to the brain. DBS can reduce dystonia symptoms by 25% to 80%, especially in people for whom medical therapy has been unsuccessful.

Occupational, Speech, and Physical Therapy for Dystonia

Many forms of dystonia affect mobility, posture, balance, stamina, and the ability to complete everyday tasks. Physical therapy can help improve flexibility and strengthen weakened muscles.

Spasmodic dystonia or voice dystonia can cause involuntary spasms in the throat muscles that are responsible for speech, resulting in a change in vocal quality. People with these types of dystonia might benefit from speech therapy.