Dystonia is a movement disorder caused by dysfunction (or abnormal functioning) of the brain that causes involuntarily muscle contractions in the body. This can be painful and disruptive to normal activities like walking, eating and speaking and typically worsens over time. Dr. Robert Goodman of the Center for Movement Disorders says, “Dystonia is a very unusual problem that is variable from person to person and can be difficult to diagnose. Though the outward manifestation can be the same, there are numerous causes.” He goes on to say, “A correct diagnosis is essential for determining treatment.” Dystonia can be genetic, caused by an injury, result from certain drug reactions, or be “psychogenic” (a stress response).

The first line of treatment is usually medication. Botox injections, can also be used to specifically relax the muscles that are involuntarily contracting. When these treatments aren’t enough, neurosurgeons can implant a Deep Brain Stimulator (DBS). Dr. Goodman, who specializes in this procedure, says this can be a very effective treatment for the right patient. He says the best candidates for this kind of surgery have what is called “idiopathic dystonia,” a genetic form of the disorder.

DBS implantation is done by surgeons who specialize in surgery for movement disorders such as Parkinson’s and Essential Tremor. They know that there are certain brain areas (“nuclei”) that are involved in causing the abnormal movements and place an electrode there. The electrode attaches to a small generator that is implanted in the patient’s chest. The electrode in the brain delivers electrical impulses that can modify the misfiring in the area.

Dr. Goodman emphasizes that treatment of these patients requires a team effort. “I work closely with neurologists who specialize in the specific movement disorder of the patient. These neurologists must make the correct diagnosis and play an essential role in patient care after the stimulator has been implanted.”

Though we can’t be sure of her diagnosis or what caused it, Desiree Jennings’ condition is unfortunate. How she ultimately fares, only time, and a good team of doctors will tell.

Video of Desiree Jennings on Inside Edition

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If dystonia causes any type of impairment, it is because involuntary muscle contractions interfere with normal function. Features such as cognition, strength, and the senses, including vision and hearing are normal. It is the third most common movement disorder after Parkinson’s Disease and Tremor, affecting more than 300,000 people in North America. Dystonia affects all races and ethnic groups.

Although there is currently no known cure for dystonia, we are gaining a better understanding of the disorder through research and are developing new approaches to treatments.

Types and Causes

Dystonia is often hereditary. Occasionally, symptoms of dystonia may be brought on by antipsychotic and antiemetic medications, which block dopamine receptors in the central nervous system.

Primary dystonia is believed to be due to abnormal functioning of the basal ganglia, deep brain structures involved with the control of movement. The basal ganglia assists in initiating and regulating movement. An imbalance of dopamine, a neurotransmitter in the basal ganglia, may underlie several different forms of dystonia, but more research is needed to improve our understanding of the brain mechanisms involved with dystonia.

Secondary forms of dystonia arise from and can be attributed to a number of factors, such as birth injury, trauma, toxins, or stroke. Secondary dystonia can also occur in association with other disorders such as Wilson’s disease. When dystonia is secondary to certain injuries or small strokes, lesions are often found in the putamen, one nucleus in the basal ganglia, as well as in certain nearby structures. Even though we can see no microscopic abnormalities of the brain in the great majority of cases of dystonia, including those with generalized dystonia, the evidence is so clear in the secondary dystonias that we believe the same part of the brain is also involved in primary dystonia.

Diagnosis

At this time, the diagnosis of dystonia rests solely on the information from the affected individual and the physical and neurological examination. In order to correctly diagnose dystonia, doctors must be able to recognize the physical signs and be familiar with the symptoms. In certain instances, further tests may be ordered to be sure that there are not other problems associated with dystonia, but in many cases these tests will be normal.

When dystonia begins, often it may change significantly with different actions. For example, dystonia of the foot may occur when walking forward but disappear completely when walking backward or while sitting in a chair. In some people, dystonia involving the hand will only happen when writing and not with any other activity. The changeable nature of dystonia has led some physicians and even some dystonia-affected persons wondering if the cause of dystonia may be “all in their head.” This is not true. Dystonia is a neurologic condition that is not the result of a psychiatric problem. In order to diagnose dystonia, a doctor who is familiar with the disorder is necessary.

If dystonia is diagnosed it is important to remember that features such as cognition, strength, and the senses, including vision and hearing, are normal.

In primary dystonia, the MRI is normal. Blood tests are normal, and electrophysiology is, to a large degree, also normal. As far as secondary dystonia, it depends upon the underlying cause. A brain MRI often detects an abnormality that reveals the cause.

Prognosis

Dystonia is not fatal, but it is a chronic disorder and its prognosis is difficult to predict.

In very severe, generalized dystonia, affecting all body areas, there can be problems that may arise secondary to the dystonia which can cause medical illnesses. However, these instances are quite rare and usually treatable.

Recognizing symptoms and diagnosing dystonia

Unless dystonia is caused by medication, symptoms usually appear in childhood. Symptoms may include involuntary blinking, jaw-grinding, grimacing, and other abnormal movements.

Dystonia is primarily characterized by an involuntary sustained twisting or cramping posture. Tremor is not a primary symptom of dystonia. If someone began having a tremor, we would not necessarily expect dystonic postures as well. However, tremor can sometimes be seen as a secondary symptom. For instance, many patients with cervical dystonia will also have an associated head tremor and some patients with writer’s cramp will have an associated writing tremor of the hand. Dystonic tremors are quite variable in their presentation and on some occasions can look like essential tremor. They are, however, seldom seen in isolation and usually are associated with dystonic posturing. The tremors are also sometimes somewhat more irregular than what is seen with essential tremor. Essential tremor and dystonia tremor may look the same, and both can be genetic.

Symptoms of dystonia and parkinsonism can sometimes run together in the same patient because both of these movement disorders seem to arise from involvement of the basal ganglia in the brain. Both parkinsonism and dystonia can each be caused by a great many disorders, and some of these disorders actually have features of both parkinsonism and dystonia.

Treating dystonia

Treatment for dystonia is designed to help lessen the symptoms of spasms, pain, and disturbed postures and functions. Most therapies are symptomatic, attempting to cover up or release the dystonic spasms. No single strategy is appropriate for every case.

The goal of treatment is to allow the patient to lead a fuller, more productive life by reducing the effects of dystonia. Establishing a satisfactory regimen requires patience on the part of both the affected individual and the physician. The approach for treatment of dystonia is usually three-tiered: oral medications, botulinum toxin injections, and surgery. These therapies may be used in alone or in combination.

Complementary care, such as physical therapy and speech therapy, may also have a role in the treatment management depending on the form of dystonia. For many people, supportive therapy provides an important adjunct to medical treatments. Medications that block acetylcholine, a brain chemical involved in movement, and other therapies may help reduce symptoms.