Causes and risk factors
The causes of dystonia are not yet known. They are categorized as follows-Primary and secondary dystonia. If the cause is genetic or when there is no identifiable cause it is primary dystonia. Genetic mutations i.e. mutations in DYT1 gene causes dystonia. Secondary dystonia refers to dystonia due to an underlying condition or injury. Common causes include stroke, brain injury, encephalitis [infection of the brain] , Parkinson’s disease or psychogenic. If the disease occurs prior to age 30 it is called as childhood or early onset dystonia. If it occurs beyond 30 years it is called as adult or late onset dystonia.
Clinical presentation
The clinical presentation varies according to the type of dystonia. It is classified as – focal dystonia – affecting only one part of the body; segmental dystonia when one or more connected body parts are affected. Generalized dystonia when trunk, limbs and general body is affected. When it affects muscles of one side of body it is called as hemidystonia. Many times the disease is seen only while performing some specific activity which is called as task specific dystonia. When the symptoms are seen to occur intermittently in episodes it is called paroxysmal dystonia. Early symptoms of dystonia includes a “dragging leg”, cramping of the foot, involuntary pulling of the neck, uncontrollable blinking, tremors, and speech difficulties. The initial symptoms are mild and are noticeable only after prolonged exertion, stress, or fatigue. Over a period of time, the symptoms may become more prominent.
Investigation
Medical history by the patient and Clinical examination by the doctor helps in diagnosis. Routine blood test is recommended. Imaging studies such as CT scan and MRI of brain is useful for further evaluation. EMG [electromyography] for measuring electrical activity in muscles is advised.
Treatment
Treatment depends upon the type of dystonia and the nature of the symptoms. Treatment such as Botulinum toxin which is injected into the affected muscles to temporarily weaken them and reduce spasms. Medication such as muscle relaxants are prescribed. Physiotherapy is advised to improve range of motion and posture and prevent muscle weakness. Occupational therapy, speech therapy will also help in managing dystonia. Surgery such as selective peripheral denervation may be required if other treatments are unsuccessful.
Other Modes of treatment
The other modes of treatment can also be effective in treating dystonia. Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating dystonia.
