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Dystonia is a movement disorder characterized by involuntary contractions and spasms of muscles. These actions force the body into repetitive, often twisting, movements and awkward, irregular postures. Dystonia, which may affect a single body area or be generalized through multiple muscle groups, affects men, women, and children of all ages and backgrounds. Experts estimate that a minimum of 300,000 people in North America have a form of dystonia.
Dystonia may be associated with dozens of diseases and conditions and show in different forms. Because movement disorders disrupt complex functions in the brain and nervous system, researchers continue to seek multiple causes for dystonia and other conditions in this category. While there are exceptions (for example, rapid-onset dystonia-Parkinsonism or cases linked with injury or drug reactions), dystonia typically develops in a slow and gradual fashion, with mild symptoms. It affects muscles that may be controlled voluntarily in normal instance; it does not affect smooth muscle, as is found in the heart and bladder.
Depending on how the disorder affects patients, they may begin to experience cramps, jerky or spasmodic muscle actions and loss of control of parts or areas of their body. These may grow more severe and result in the distinctive twisting and awkward postures that most people associate with this condition.
Causes and Risk Factors for Dystonia
Movement disorders disrupt complex functions in the brain and nervous system making it difficult to pinpoint a single cause for dystonia, especially since it may be a condition on its own or may be associated with other diseases or afflictions. Dystonia may arise from injury or trauma, stroke, taking certain medications or a genetic predisposition.
Researchers have focused most intensively in recent times on the mechanics and biochemistry of the brain, as well as genetics of certain notable forms of this condition, to resolve some of the mysteries of dystonia.
Physicians' observation, skill and experience play a key role in determining whether a patient is suffering from dystonia as a singular condition or in association with other diseases or maladies, and in what form. To help them make a diagnosis of dystonia, physicians may take detailed individual and family histories and perform laboratory tests on blood and urine and electrical activity in the brain, to help them make a dystonia diagnosis. Patients also may be asked to undergo genetic and other screenings, depending on the suspected form of dystonia.
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Dystonia is a chronic condition that requires carefully tailored and customized care as each case is unique. Treatment typically consists of multiple strategies and may be affected by factors, including the age, overall health and the severity of the given patient's disorder. Some patients may achieve satisfactory outcomes with medical management, including the administration of medications, including those that aim at imbalances or deficiencies in neurotransmitters in the brain; some may respond well to injections, especially of Botulinum neurotoxin.
Dr. Tagliati employs botulinum neurotoxin (also known by trade names: Botox®, Dysport®, Myobloc®, Xeomin®) using electromyography and needles that can simultaneously record the electrical activity of the muscle and inject the drug. The toxin gets absorbed by nerve terminals and prevents nerves from secreting neurotransmitters. The net effect is the muscles are less stimulated by the nerves and so they calm down.
Precisely placed injections can help control eye spasms, facial spasms, the blinking and chin thrusting of Meige's syndrome, the stiff neck of torticollis, the arm or leg muscle spasms of focal limb dystonia or the muscle contractions of spasticity.
Dystonia may also be treated with a range of surgical options, specifically deep brain stimulation (DBS). In DBS, leads are implanted deep in the brain and electrical stimulation is targeted at key sites to try to control shaking, stiffness and loss of muscle control.
Advances in technology, particularly in medical imaging and in devices, may combine with great surgical skill and significant clinical experience in treating movement disorders to provide very satisfying outcomes for dystonia patients, particularly those with childhood onset of this condition.