Dystonia
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Dystonia is a movement disorder that causes a disruption in the regulation of muscle tone. This disruption causes the muscle to involuntarily contract and can cause progressive rigidity in different areas of the body. Dystonia can cause increased tone in opposing muscles of the affected area of the body that can hinder movement. If the increase in tone is not symmetrical it can cause abnormal posturing.
Causes
While there are a number of potential causes of this condition, the exact cause has not yet been identified. Many feel that it may be related to the communication process between the brain’s nerve cells in regions like the basal ganglia. This region is where nerve signals related to muscle contractions are processed and fine-tuned.
In some cases, such as with primary or idiopathic dystonia, the condition is sometimes a hereditary issue. Family members may be carriers that do not display symptoms.
Dystonia can be associated with health issues like Parkinson’s disease, Wilson’s disease, brain tumors, and Huntington’s disease.
In cases where dystonia is acquired due to basal ganglia damage, this trauma can come about due to a stroke, a birth injury, carbon monoxide or lead poisoning, encephalitis, tuberculosis, oxygen deprivation, or reactions to medications.
Symptoms
Dystonia can occur in patients as young as three, although it typically occurs just before puberty. When Dystonia occurs in younger patients it primarily impacts the legs and can hinder the patient’s ability to walk normally. Younger patients with dystonia tend to experience a more rapid progression of the issue.
If dystonia develops later in life, it can affect the trunk of the body and the neck as well as the legs. The issue can reach the point where the sufferer is rendered completely immobile. Death may occur as a result of secondary complications such as pneumonia.
There are multiple types of dystonia:
- Primary dystonia – Caused by gene mutation
- Secondary dystonia – Caused by an injury to the nervous system
- Generalized dystonia – Occurs throughout the body
- Focal dystonia – Occurs in a specific area of the body
- Segmental dystonia – Occurs in two adjoining body parts
Diagnosing Dystonia
Dr. Pouratian will make a diagnosis of dystonia based on your family history, medical history, and symptoms. Dystonia can also be diagnosed based on your physical and neurological examination results. Most often, Dr. Pouratian will work with a movement disorders neurologist to ensure the proper diagnosis and to make sure all medical (non-surgical) therapies have been exhausted.
Dr. Pouratian may prescribe tests such as blood tests, imaging tests, and EEG or EMG tests to rule out other disorders and diseases that cause similar symptoms.
Some types of dystonia are linked to specific genes. Dr. Pouratian may perform genetic testing as part of the diagnosis process.
Once Dr. Pouratian has identified the type of dystonia you are experiencing and has developed a thorough understanding of your case, he will be able to create a specialized treatment plan. He will discuss the recommended treatment modalities with you in great detail and will answer any questions that you may have. A schedule will then be set for your course of treatment.
Treating Dystonia
The primary medical therapy for dystonia is targeted botulinum toxin injections. Injections of botulinum neurotoxin (BNT) are a targeted treatment for dystonia symptoms.
BNT is derived from the bacterium Clostridium botulinum. BNT is a biological substance that is injected into muscles to relax them and lessen muscular spasms. It works by blocking the nerve signals that cause the muscles to contract. Because the muscle is weakened, it relaxes, minimizing dystonia.
Patients receive BNT injections as a quick and convenient outpatient procedure with little downtime. At the injection site, minor discomfort or bruising may occur following treatment. Dr Pouratian does not perform botulinum toxin treatments. He will refer you to a movement disorders specialists for these treatments.
If botulinum toxin is ineffective, deep brain stimulation can be considered.
If deep brain stimulation is being considered, there are several factors that must be taken into consideration before surgery. These factors include the type of dystonia the patient suffers from, as deep brain stimulation is more effective in individuals with primary dystonia compared to secondary dystonia. Deep brain stimulation is also more effective in patients with general dystonia than it is in individuals who suffer from focal dystonia. Still, with increasing experience, patients with secondary dystonias and focal dystonias are still considered for treatment. Deep brain stimulation has been shown to be effective in about 50% to 70% of patients. The effect of deep brain stimulation can take up to 6-12 months to become apparent. Throughout this time, close management and follow-up by a movement disorders neurologist is required.
Arrange Your Consultation
Contact us today to schedule a consultation with Dr. Nader Pouratian to learn more about dystonia in Dallas and Fort Worth. Dr. Pouratian can create a treatment plan to help you safely and effectively control the symptoms of dystonia.
