The Dystonia Patient: A Guide to Practical Management

The Dystonia Patient A Guide To Practical Management (Pb 2009)
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Even in the absence of traditional "cerebellar signs" in most dystonia patients, there are more subtle indications of cerebellar dysfunction.

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It is clear that as long as the cerebellum's role in dystonia genesis remains unexamined, it will be difficult to significantly improve the current standards of dystonia treatment or to provide curative treatment. Reducing the types of movements that trigger or worsen dystonic symptoms provides some relief, as does reducing stress, getting plenty of rest, moderate exercise, and relaxation techniques. A geste antagoniste is a physical gesture or position such as touching one's chin that temporarily interrupts dystonia, it is also known as a sensory trick.

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While research in the area of effectiveness of physical therapy intervention for dystonia remains weak, [24] there is reason to believe that rehabilitation can benefit dystonia patients. Potential treatment interventions include splinting, [27] therapeutic exercise, manual stretching , soft tissue and joint mobilization , postural training and bracing, [25] neuromuscular electrical stimulation , constraint-induced movement therapy , activity and environmental modification, and gait training.

A patient with dystonia may have significant challenges in activities of daily living ADL , an area especially suited for treatment by occupational therapy OT. An occupational therapist OT may perform needed upper extremity splinting, provide movement inhibitory techniques, train fine motor coordination, provide an assistive device, or teach alternative methods of activity performance to achieve a patient's goals for bathing, dressing, toileting, and other valued activities.

Recent research has investigated further into the role of physiotherapy in the treatment of dystonia. Since the root of the problem is neurological, doctors have explored sensorimotor retraining activities to enable the brain to "rewire" itself and eliminate dystonic movements. The work of several doctors such as Nancy Byl and Joaquin Farias has shown that sensorimotor retraining activities and proprioceptive stimulation can induce neuroplasticity , making it possible for patients to recover substantial function that was lost due to Cervical Dystonia, hand dystonia, blepharospasm, oromandibular dystonia, dysphonia and musicians' dystonia.

Some focal dystonias have been proven treatable through movement retraining in the Taubman approach, particularly in the case of musicians. However other focal dystonias may not respond and may even be made worse by this treatment.


In others, the symptoms may progress to total disability, making some of the more risky forms of treatment worth considering. Combe L, Abu-Arafeh I. This content does not have an Arabic version. Dosing was generally in accordance with that recommended in the abobotulinumtoxinA prescribing information [ 19 , 28 ]. You must have JavaScript enabled in your browser to utilize the functionality of this website. Galene editions In some cases with patients who already have dystonia, a subsequent tramatic injury or the effects of general anethesia during an unrelated surgery can cause the symptoms to progress rapidly.

Due to the rare and variable nature of dystonia, research investigating the effectiveness of these treatments is limited. There is no gold standard for physiotherapy rehabilitation. Different medications are tried in an effort to find a combination that is effective for a specific person. Not all people respond well to the same medications.


"Written by the dystonia team at the University of Florida Movement Disorders Center, this book is designed as a practical and complete guide to the integrated . Editorial Reviews. Review. "Okun's remarkable page practical guide, "The Dystonia Patient," is the first book that exclusively focuses on patients diagnosed .

Medications that have had positive results in some include: diphenhydramine , benzatropine and atropine. Medications such as anticholinergics benztropine , which act as inhibitors of the neurotransmitter acetylcholine , may provide some relief. In the case of an acute dystonic reaction, diphenhydramine is sometimes used though this drug is well known as an antihistamine , in this context it is being used primarily for its anticholinergic role.

See also Procyclidine. A baclofen pump has been used to treat patients of all ages exhibiting muscle spasticity along with dystonia. The pump delivers baclofen via a catheter to the thecal space surrounding the spinal cord. The pump itself is placed in the abdomen. It can be refilled periodically by access through the skin. Baclofen can also be taken in tablet form [38]. Botulinum toxin injections into affected muscles have proved quite successful in providing some relief for around 3—6 months, depending on the kind of dystonia.

Botox or Dysport injections have the advantage of ready availability the same form is used for cosmetic surgery and the effects are not permanent. There is a risk of temporary paralysis of the muscles being injected or the leaking of the toxin into adjacent muscle groups, causing weakness or paralysis in them. Clonazepam , an anti-seizure medicine, is also sometimes prescribed. However, for most, their effects are limited and side-effects like mental confusion, sedation, mood swings, and short-term memory loss occur.

Although this does not remove the condition, it does alleviate the symptoms most of the time. In contrast, dopamine antagonists can sometimes cause dystonia.

One complex case study found that a ketogenic type diet may have been helpful in reducing symptoms associated with alternating hemiplegia of childhood AHC of a young child. However, as the researchers noted, their results could have been corollary in nature and not due to the diet itself, though future research is warranted.

Surgery, such as the denervation of selected muscles, may also provide some relief; however, the destruction of nerves in the limbs or brain is not reversible and should be considered only in the most extreme cases. Recently, the procedure of deep brain stimulation DBS has proven successful in a number of cases of severe generalised dystonia.

However, reference data of patients without DBS therapy are lacking. The Italian Bernardino Ramazzini provided one of the first descriptions of task-specific dystonia in in a book of occupational diseases, The Morbis Artificum. These historical reports usually attributed the etiology of the motor abnormalities to overuse. Then, dystonia were reported in detail in , when Hermann Oppenheim , [43] Edward Flatau and Wladyslaw Sterling described some Jewish children affected by a syndrome that was retrospectively considered to represent familial cases of DYT1 dystonia.

Some decades later, in , the first international conference on dystonia was held in New York. These forms were previously considered independent disorders and were mainly classified among neuroses. A modern definition of dystonia was worded some years later, in During the following years it became evident that dystonia syndromes are numerous and diversified, new terminological descriptors e.

The clinical complexity of dystonia was then fully recognized.


Images, videos and audio are available under their respective licenses. Home FAQ Contact. Dystonia Wikipedia open wikipedia design. Neurological movement disorder. Main article: Focal dystonia. Play media. Archived from the original on 23 April Retrieved 2 May Current Opinion in Neurology. Archived from the original on 15 November Annals of Neurology. George-Hyssop, P. The American Journal of Human Genetics. Revue Neurologique in French. Current Neurology and Neuroscience Reports.

Jon; Allanson, Judith E. Veterinary and Human Toxicology. Movement Disorders. L; Aminoff, M. J Bibcode : PLoSO Frontiers in Physiology. Nature Neuroscience. Clinical Neurophysiology.


Koller McGraw-Hill Professional. Retrieved 30 May Archived from the original on 2 June Retrieved 7 June E Physical Therapy. Current Treatment Options in Neurology. In Okun, M. New York: Demos Medical. Journal of Tokushima. Retrieved 6 May Physiotherapy Theory and Practice. Federico Bitti.

Cervical Dystonia. Rewiring the brain through dance. Archived from the original on 25 January Retrieved 24 January Joaquin Farias. Your movement can heal your brain. Archived from the original on 26 January Choosing music over meds, one man's quest to retrain his brain to overcome dystonia. How your movements can heal your brain. An essay on the neurodynamics of dystonia. How to induce neuroplasticity. Side effects from treatment and medications can also present challenges in normal activities.

In some cases, symptoms may progress and then plateau for years, or stop progressing entirely. The progression may be delayed by treatment or adaptive lifestyle changes, while forced continued use may make symptoms progress more rapidly. In others, the symptoms may progress to total disability, making some of the more risky forms of treatment worth considering. In some cases with patients who already have dystonia, a subsequent tramatic injury or the effects of general anethesia during an unrelated surgery can cause the symptoms to progress rapidly. An accurate diagnosis may be difficult because of the way the disorder manifests itself.

Sufferers may be diagnosed as having similar and perhaps related disorders including Parkinson's disease , essential tremor , carpal tunnel syndrome , TMD , Tourette's syndrome , or other neuromuscular movement disorders. The causes of dystonia are not yet known or understood; however, they are categorized as follows on a theoretical basis:. Primary dystonia is suspected to be caused by a pathology of the central nervous system , likely originating in those parts of the brain concerned with motor function, such as the basal ganglia , and the GABA gamma-aminobutyric acid producing Purkinje neurons.

The precise cause of primary dystonia is unknown. In many cases it may involve some genetic predisposition towards the disorder combined with environmental conditions. Secondary dystonia refers to dystonia brought on by some identified cause, usually involving brain damage, or by some unidentified cause such as chemical imbalance. Some cases of particularly focal dystonia are brought on after trauma, are induced by certain drugs tardive dystonia , or may be the result of diseases of the nervous system such as Wilson's disease.

Environmental and task-related factors are suspected to trigger the development of focal dystonias because they appear disproportionately in individuals who perform high precision hand movements such as musicians, engineers, architects and artists.

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Chlorpromazine can also cause dystonia, which can be often misjudged as a seizure. Neuroleptic drugs often cause dystonia, including oculogyric crisis. Treatment has been limited to minimizing the symptoms of the disorder as there is yet no successful treatment for its cause. Reducing the types of movements that trigger or worsen dystonic symptoms provides some relief, as does reducing stress, getting plenty of rest, moderate exercise, and relaxation techniques.

Various treatments focus on sedating brain functions or blocking nerve communications with the muscles via drugs, neuro-suppression or denervation. All current treatments have negative side effects and risks.