Why Is Dystonia Painful
The disorder is usually not associated with pain, but it certainly may lead to pain in affected areas. Cervical dystonia can be particularly painful due to degeneration of the spine, irritation of nerve roots or frequent headaches. Limb dystonia may not cause pain initially but may become painful over time.
Treating Dystonia In Parkinsons
Treatment options for dystonia include:
- Dopaminergic medication adjustment as discussed above
- Botulinum toxin injections of the affected muscles
- Physical therapy to loosen and strengthen the dystonic body part
- Trying other medications that target the dystonia directly such as muscle relaxants or anti-cholinergic medications
- Use of a device to provide a sensory trick*.
- Deep brain stimulation can be considered in difficult-to-treat situations
*To minimize their dystonia, some people have success using an interesting tactic called a sensory trick. A sensory trick is defined as a physical gesture that mitigates the production of the dystonia. For example, touching the eyebrow may help keep the eyes open, or touching the chin may keep the neck from twisting. In my clinical practice, one woman wears metals rings on her dystonic fingers to help them assume a more normal position. Another man wears 5-toed shoes to prevent dystonic toe curling
What Do Researchers Know About Dystonia
Researchers believe that dystonia results from an abnormality in or damage to the basal ganglia or other brain regions that control movement. There may be abnormalities in the brains ability to process a group of chemicals called neurotransmitters that help cells in the brain communicate with each other. There also may be abnormalities in the way the brain processes information and generates commands to move.;In most cases, no abnormalities are visible using magnetic resonance imaging or other diagnostic imaging.;
The dystonias can be divided into three groups:; idiopathic, genetic, and acquired.
Idiopathic dystonia;refers to dystonia that does not have a clear cause.; Many instances of dystonia are idiopathic.;
There are several;genetic;causes of dystonia. ;Symptoms may vary widely in type and severity even among members of the same family. In some instances, people who inherit the defective gene may not develop dystonia.;Having one mutated gene appears to be sufficient to cause the chemical imbalances that may lead to dystonia, but other genetic or even environmental factors may play a role.;Forms of dystonia for which the genetic cause is known include:
Recently, researchers have identified other genetic causes of dystonia, including one resulting from mutations in the DYT6 gene.;Dystonia caused by DYT6 mutations often presents as cranial dystonia, cervical dystonia, or arm dystonia. Rarely, a leg is affected at the onset.;
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Dementia With Lewy Bodies
- Dementia with Lewy bodies is a progressive, neurodegenerative disorder in which abnormal deposits of a protein called alpha-synuclein;build up in multiple areas of the brain.
- Dementia with;Lewy bodies;is second to Alzheimers as the most common cause of degenerative dementia that;first causes progressive problems with memory and fluctuations in thinking, as well as hallucinations. These symptoms are joined later in the course of the disease by parkinsonism with slowness, stiffness and other symptoms similar to PD.
- While the same abnormal protein is found in the brains of those with PD, when individuals with PD develop memory and thinking problems it tends to occur later in the course of the disease.
- There are no specific treatments for DLB. Treatment focuses on symptoms.
The Different Types Of Dystonia
Within the context of Parkinsons disease, there are two main forms of dystonia:
- Primary: When dystonia is the star of the show and doesnt share its fame with other symptoms.; This form of dystonia is thought to be driven by genetics and is the most common and debilitating form. Primary dystonia can lead to generalized dystonia, this is when the legs, body, arms and more can be affected by the painful contractions
- Secondary dystonia is typically triggered by a number of things such as trauma, drugs or exposure to toxins.; It can also be triggered by neurological disorders like Parkinsons or others.
Outside of Parkinsons, there are a number of forms of dystonia as well:
- Paroxysmal dystonia: This is recognized by sudden episodes of involuntary movements
- Dope-responsive dystonia:; A genetic condition that starts in childhood
- Myoclonus-dystonia: Another form that starts in childhood, but this one is known for rapid muscle movements and contractions.
- Rapid-onset dystonia Parkinsons: As the name suggests, this is a rare form that causes a very fast development of dystonia and Parkinson’s-like symptoms at the same time.
Aside from Parkinsons and like many other neurological disorders, dystonia can show-up as a symptom of other conditions, as well as Wilsons disease. Regardless of whether its tied to Parkinsons, Wilsons or appearing on its own, the symptoms and painful muscle contractions remain the same.
Dystonia Or Muscle Cramps
Muscle cramps and dystonia occur when one of your muscles, or a group of muscles, tightens or shortens involuntarily.
Muscle cramps and dystonia can be confusing as they can feel very similar. You may not always be able to tell the difference between them, but they are caused by separate problems and are therefore treated differently.
Muscle cramps in Parkinsons are generally caused by muscular rigidity and reduced movement rather than by muscles contracting. But, like dystonia, cramps can also be painful and very distressing.
Normal painkillers do not usually relieve them, but cramps often respond well to massage and the use of a hot water bottle or heated pad. Movement and exercise may also help to release cramps and reduce stiffness. If these do not help, then your doctor may prescribe muscle relaxants.
Body Parts That Can Be Affected With Dystonia In Parkinsons
Repetitive and sustained eye closure is known as blepharospasm. To the observer, this looks like increased blinking, which may increase in certain situations such as in bright light. The frequent blinking/eye closures can interfere with activities such as reading or driving.; This can be associated with PD, but may also accompany other forms of parkinsonism such as Progressive Supranuclear Palsy. The most common treatment for this disorder is Botulinum toxin injections.
In PD, the trunk can tilt to one side or flex forward. Forward flexion of the trunk is known as camptocormia. Similar to neck flexion, it is unclear whether the flexion is due to dystonia causing overactivity of muscles that pull the trunk down, or weakness of the muscles that keep the trunk upright. Typically, although the forward flexion may appear very profound when upright, the patient can lie flat in a bed or sometimes even straighten up against a wall, demonstrating that the flexion is not due to a permanent deformation. Treatment options are similar to those available for neck flexion. Spinal surgeries which attempt to straighten the torso have been reported in a handful of patients. Results were mixed including a very high rate of surgical complications.; These surgeries are generally not performed.
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Can You Work If You Have Dystonia
When dystonia is severe and prevents employment, it can qualify for Social Security Disability benefits. Although the Social Security Administration has no disability listing for dystonia, there are still several ways to qualify for benefits, including: Meeting a listing for another impairment you have.
Tic And Tourette Syndrome:
Motor tics are repetitive, usually quick movements that can usually be suppressed by the person who has them, at least for a few seconds. They are not a nervous habit, but are believed to be neurological in their origin. Tourette syndrome is the name applied when motor tics associated with vocal tics begin in childhood, last longer than a year, and change over time. Most people who have Tourette syndrome do not have the famous symptom of uttering obscenities.
Tic is common, particularly in childhood, and may improve or cease altogether as one grows older. Occasionally it is sufficiently troubling that medication is warranted. Teasing from other children, or misunderstanding and criticism from parents and teachers are sometimes more problematic than the tic itself.
Are There Any Promising New Potential Treatments Being Developed
One of the most interesting new approaches currently being explored for dystonia is non invasive brain stimulation using approaches like Transcranial Magnetic Stimulation and transcranial direct current stimulation .
In these therapies, a magnetic coil is placed over the skull and used to focus a small magnetic or electrical pulse painlessly into the brain. The pulse stimulates cells within the brain in an attempt to disrupt the faulty messages that may be causing dystonia.
There have already been some promising results published from small studies which involved people with non-Parkinsons forms of dystonia, and my colleagues here at University College London are now exploring whether this experimental therapy might be helpful for people with Parkinsons.
Dystonia Vs Dyskinesia In Parkinson’s Disease
Claudia Chaves, MD, is board-certified in cerebrovascular disease and neurology with a subspecialty certification in vascular neurology.
Dystonia and dyskinesia are movement problems that commonly occur in Parkinsons disease . You may experience one or both of them, particularly in late-stage PD. Dystonia is muscle stiffening caused by PD, while dyskinesia is a type of muscle twisting caused by some PD medications.
Dystonia and dyskinesia can both cause distress, and they are distinguished from each other based on their visible features. They can be managed with medication or surgery, typically with a moderate improvement of symptoms.
PD is characterized by four primary symptoms:
- Resting tremor
- Postural instability
While they can fluctuate in severity, the primary symptoms of PD tend to be present most of the time.
Dystonia and dyskinesia are recurrent, abrupt, and short-lived muscle movements. Not everyone who has PD experiences dystonia and dyskinesia. If they do, the symptoms they experience can be telling.
Affects large muscle groups
Smooth, repetitive movement often described as a rolling or writing motion
Can begin suddenly and stop after several minutes
Not typically painful
More likely to occur when PD medication effects are at their peak
With dyskinesia, you may experience a snakelike twisting of your arm or movements of your head and neck that appear like dancing in slow motion.
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Terms Used To Describe Rapid
The classic features of RDP include involuntary dystonic spasms in the limbs, prominent involvement of the speech and swallowing muscles, slowness of movement, and poor balance. Onset of the combined dystonic and parkinsonian symptoms can be sudden, occurring over hours to days. Some people experience seizures. RDP often follows a fever, prolonged exposure to heat or exercise, childbirth, or emotional stress. Symptoms usually stabilize in less than four weeks, after which, it is reported, there is little progression and symptoms may improve slightly. RDP usually occurs in adolescence or young adulthood , but onset of mild dystonia-parkinsonism has been reported in individuals up to the age of 58.
Several mutations in the ATP1A3 gene are associated with RDP and inherited autosomal dominantly with reduced penetrance. This means that only one parents needs to have the gene mutation for a child to inherit the disease, but not everyone who inherits the gene mutation will develop symptoms.
Diagnosis is based on neurological examination. A family history is required to distinguish the mild limb dystonia of RDP from early-onset dystonia.
How Does Dystonia Usually Affect People With Parkinsons
Dystonia can affect people with Parkinsons in different ways at different times.
Some people with young onset forms of the condition, may experience dystonia as one of their first symptoms. Often the dystonia affects the feet and causes them to turn inwards and is exertion-induced, so people may find get it in their feet after running or walking.
Other people may experience dystonia during off periods when the effects of their Parkinsons medication wear off.
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How Might Dystonia Be Experienced
- Feet: people with Parkinsons mainly experience dystonia in their feet. Typically the toes curl up into a claw-like position, the foot turns inwards at the ankle, and occasionally the big toe sticks up. This position, caused by spasms in the calf muscles, can be very uncomfortable and makes it hard to fit feet into tight shoes.
- Hands: writers cramp in the hands only occurs during handwriting.
- Neck: cervical dystonia affects the neck muscles, which causes the head to twist to one side, forwards or occasionally backwards.
- Eyelids: the eyelid muscles may contract and make the eye close involuntarily . This is often experienced as excessive blinking, intolerance to light, a burning feeling in the eye or irritation.
- Vocal cords: dystonia affecting the vocal cords or speech muscles makes speaking difficult or strained.
- Jaw area and side of the face:oromandibular dystonia affects the jaw area, tongue, mouth or one side of the face. The jaw may be pulled either open or shut, and speech and swallowing can be difficult.
Deep Brain Stimulation Surgery For Dystonia At Ucla
If you’ve been diagnosed with dystonia, your doctor will start with medications. There are many prescription drug options to treat dystonia including botox injections, but often they do not completely relieve symptoms. If medications fail to work for you and your physical symptoms have become debilitating, your doctor may recommend deep brain stimulation.
Deep brain stimulation involves implanting electrodes, or wires, deep inside the brain to change irregular brain activity. Learn more about deep brain stimulation.
Where Can I Get More Information
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network at:
Office of Communications and Public LiaisonNational Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesda, MD 20892
NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.
How Can I Help Myself
You will need to try a variety of sensory tricks to see what works for you as dystonia affects everyone differently.
Spasms may be reduced by touching the affected part of the body either before or during any movement known to trigger dystonia. Although this may not prevent or stop a spasm, touching can distract or trick the brain and reduce the length and intensity of a muscle contraction.
Simple massage exerting pressure on the foot, or the use of a hot water bottle or heated pad can also help, as can movement and exercise – see Coping Strategies – Tips & Tricks.
For eye spasms, some people find lying down, singing, yawning, laughing, chewing, putting pressure on the eyebrows or just talking can help. Spasms in the vocal cords may respond to yawning or sneezing.
Simply relaxing may also help so try taking a bath, having a massage or a calming activity such as yoga.
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What Are The Signs And Symptoms Of Dystonia
Signs and symptoms of dystonia include:
- Muscle contractions that result in flexed or twisted movements and abnormal positions.
- Pain that results from abnormal movements and postures.
- Muscle movements and abnormal body positions that repeat, sometimes resembling a tremor.
- Muscle movements that may begin in one area of the body and, in time, spread to other areas.
- Muscle movements and abnormal postures that worsen with extended periods of exertion, fatigue or stress.
- Voluntary muscle movement on one side of the body that cause dystonia symptoms on the opposite side.
- Handwriting begins to be sloppy.
- Foot cramps.
What Are The Current Treatment Approaches
As with so many aspects of Parkinsons, there is no one size fits all approach for treating dystonia, but there are a range of things that can be helpful, including:
- Adjusting Parkinsons medication. This may include using fast-acting or longer-acting drugs, which can be effective if people experience dystonia primarily when their Parkinsons medication wears off.
- Non-drug approaches. Some people may also find that being relaxed helps with their dystonia. What makes someone relax differs from one person to the next, but you may find having a warm bath or massage helpful, or trying complementary therapies such as yoga.
- Other drug treatments. There are a range of different drugs that can be used to help to relax muscles, and in some cases Botulinum Toxin injections can be helpful.
- Surgery. Surgery for dystonia is not common, but may be considered if you dont respond to drug treatment. Surgical procedures that are already used for Parkinsons, such as deep brain stimulation, have been shown to help dystonia.
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What Can Cause Dystonia
What can cause dystonia? Some causes of acquired dystonia include birth injury , certain infections, reactions to certain drugs, heavy metal or carbon monoxide poisoning, trauma, or stroke.
Can anxiety cause dystonia?;Some patients report that they have never been less stressed and therefore feel that the dystonia cannot be psychogenic. However, psychogenic dystonia can occur with or without psychological symptoms. Furthermore, other forms of dystonia are often accompanied by psychological symptoms such as anxiety and depression.
Can dystonia come on suddenly?;Onset of the combined dystonic and parkinsonian symptoms can be sudden, occurring over hours to days. RDP usually occurs in adolescence or young adulthood .
Can dystonia just go away?;Dystonia is an unpredictable condition. It tends to progress slowly and the severity of a persons symptoms can vary from one day to another. Focal dystonia usually progresses gradually over a period of about five years and then doesnt get any worse. Sometimes, a persons symptoms improve or disappear completely.