At a glance
What it is
A movement disorder in which muscles contract involuntarily, causing repetitive or twisting movements and abnormal postures. Can be focal, segmental, or generalized.
Symptoms
Muscle spasms beginning in one area or during specific actions, worsening with stress or fatigue. May affect neck, eyelids, jaw, voice, or hands.
Approach
Botulinum toxin injections, oral medications, physical and speech therapy, and surgery (DBS, radiofrequency lesioning, selective denervation) for severe cases.
What dystonia is
Dystonia is a movement disorder that causes the muscles to contract involuntarily. This can cause repetitive or twisting movements.
The condition can affect one part of your body (focal dystonia), two or more adjacent parts (segmental dystonia), or all parts of your body (general dystonia). The muscle spasms can range from mild to severe. They may be painful, and they can interfere with your performance of daily tasks.
There is no cure for dystonia, but medications and therapy can improve symptoms. Surgery is sometimes used to disable or regulate nerves or certain brain regions in people with severe dystonia.
Symptoms
Dystonia affects different people in different ways. Muscle spasms might:
- Begin in a single area, such as your leg, neck or arm. Focal dystonia that begins after age 21 usually starts in the neck, arm or face. It tends to remain focal or become segmental. - Occur during a specific action, such as writing by hand. - Worsen with stress, fatigue or anxiety. - Become more noticeable over time.
Areas of the body that can be affected include:
- **Neck (cervical dystonia).** Contractions cause your head to twist and turn to one side, or pull forward or backward, sometimes causing pain. - **Eyelids.** Rapid blinking or spasms cause your eyes to close (blepharospasms) and make it difficult for you to see. Spasms usually are not painful but might increase when you are in bright light, reading, watching TV, under stress or interacting with people. Your eyes might feel dry, gritty or sensitive to light. - **Jaw or tongue (oromandibular dystonia).** You might experience slurred speech, drooling, and difficulty chewing or swallowing. Oromandibular dystonia can be painful and often occurs in combination with cervical dystonia or blepharospasm. - **Voice box and vocal cords (laryngeal dystonia).** You might have a tight or whispering voice. - **Hand and forearm.** Some types of dystonia occur only while you do a repetitive activity, such as writing (writer's dystonia) or playing a specific musical instrument (musician's dystonia). Symptoms usually do not happen when your arm is at rest.
Complications
Depending on the type of dystonia, complications can include:
- Physical disabilities that affect your performance of daily activities or specific tasks - Difficulty with vision that affects your eyelids - Difficulty with jaw movement, swallowing or speech - Pain and fatigue, due to constant contraction of your muscles - Depression, anxiety and social withdrawal
Treatment
To manage dystonia, your provider might recommend a combination of medications, therapy or surgery.
Medications
Botulinum toxin and oral drugs
- Injections of botulinum toxin into specific muscles might reduce or stop muscle spasms. Injections are usually repeated every 3 to 4 months.
- Side effects are generally mild and temporary, including weakness, dry mouth or voice changes.
- Other medications target neurotransmitters that affect muscle movement, including carbidopa-levodopa, trihexyphenidyl, benztropine, diazepam, clonazepam, baclofen, tetrabenazine and deutetrabenazine.
Therapy
Physical, occupational and speech therapy
- Physical therapy or occupational therapy or both to help ease symptoms and improve function
- Speech therapy if dystonia affects your voice
- Stretching or massage to ease muscle pain
Surgery
For severe, treatment-resistant cases
- Radiofrequency brain lesioning — an effective and safe technique done under local anesthesia while the patient is awake, allowing the surgeon to localize the targeted brain region through questions and tests
- Deep brain stimulation — electrodes implanted into a specific part of the brain and connected to a chest generator that sends electrical pulses to help control muscle contractions
- Selective denervation surgery — cutting the nerves that control muscle spasms, an option when other treatments for cervical dystonia have not worked
Book a consultation
The secretary schedules first appointments during clinic hours; please have prior imaging, operative notes and a current medication list available at the time of the call.
This page provides general information about dystonia and is not a substitute for individual medical assessment. If your symptoms are severe or worsening, contact a clinician promptly.