Dystonia
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Dystonia is a movement disorder in which faulty signals from the brain cause parts of the body to twist, jerk or assume unusual postures. At Columbia University Medical Center/NewYork-Presbyterian Hospital, our Center for Movement Disorders provides evaluation, medication, and—for patients with disabling dystonia that has resisted other treatments—state-of-the-art surgery for dystonia using Deep Brain Stimulation.
Symptoms
The movements caused by dystonia are often slow, repetitive and painful.
Dystonia can affect any part of the body, including the hands and feet, arms and legs, trunk, neck, eyelids, face or vocal cords. Initial symptoms may be mild and intermittent. They may be present only when performing specific actions or under specific conditions, such as stress or fatigue. Over time, symptoms may become more severe and/or spread to other body parts.
Dystonias are often classified by the body parts they affect:
Diagnosis
Dystonia takes so many forms and has so many underlying causes, and its onset can be so slow, that it is commonly misdiagnosed by non-specialists.
The first steps in diagnosing dystonia are usually conducting a physical examination and taking a medical history. In the medical history, the doctor will be especially interested in getting a complete list of any drugs and medications the patient has taken, and in discovering whether there is any family history of movement disorders.
Blood tests or brain scans are sometimes helpful in identifying the underlying cause of the condition.
Risk Factors
There are several possible causes of dystonia. These include:
- Inherited conditions
- Certain medications, including caffeine and some antiepileptics, antipsychotics, antidepressants, antiemeties, antihistamines, amphetamines and oral contraceptives
- Ischemic stroke
- Hemorrhagic stroke
- Arteriovenous malformation
- Brain tumor
- Other disorders, such as Huntington disease, Parkinson disease or Wilson disease
Dystonia is believed to stem from abnormal functioning of the basal ganglia, deep brain structures that assist in the initiation and regulation of movement. Some forms of dystonia are caused by physical injury to the basal ga iglia. An imbalance of dopamine may form the basis of other forms of dystonia. Research is ongoing to improve scientists’ understanding of the brain mechanisms involved with dystonia.
Treatments
There is currently no known cure for dystonia, so treatment focuses on minimizing its symptoms.
Establishing a satisfactory treatment regimen tends to require patience on the part of the affected individual and his or her care team. Often, medications must be tried to see how well they work for an individual patient, and whether the benefits of a treatment outweigh its side effects. Many oral medications can help treat the symptoms of dystonia, as can botulinum toxin injections.
At the Center for Movement Disorders, our highly experienced team uses surgery to help treat dystonias that have resisted other treatments. Our neurologists and neurosurgeons work together to determine which patients may be helped by surgery such as Deep Brain Stimulation (DBS).