Focal Dystonia

Overview

Definition

Focal dystonia (FD) is a movement problem that happens in one part of the body. You may have unusual movements, twitches, and tics. It may happen all the time or off and on. The most common types are:

  • Blepharospasm—an eye twitch
  • Cervical dystonia or spasmodic torticollis—happens to the neck
  • Segmental cranial dystonia, also known as Meige syndrome—happens to the jaw, tongue and eyes
  • Oromandibular dystonia—happens to the jaw
  • Spasmodic dysphonia—happens to the vocal cords
  • Axial dystonia—happens to the trunk
  • Dystonia of the hand/arm, such as writer's cramp

Causes

In many cases, the cause of FD is not known. In others, it may be due to genes.

FD can also be caused by a health problem, injury, or your genes. This is called secondary FD.

It may be due to:

  • Problems during birth, such as lack of oxygen
  • Infection
  • Reactions to medicines
  • Heavy metals in the body
  • Carbon monoxide poisoning
  • Trauma
  • Stroke
  • Other health problems
The Process of Carbon Monoxide Poisoning Decreasing Available Oxygen
Carbon monoxide poisoning
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Risk Factors

Having people in your family with FD raises your risk of getting it.

Having a health problem, injury, or certain genes also raises your chance of getting secondary FD.

SymptomsandDiagnosis

Symptoms

Symptoms may include:

  • Eyelid spasms
  • Rapid or uncontrollable blinking of both eyes
  • Neck twisting
  • A hard time writing
  • Foot cramps
  • Pulling or dragging of a foot
  • Shaking
  • Problems speaking

FD may get worse with:

  • Excitement
  • Stress
  • Talking
  • Being tired

Diagnosis

Your doctor will ask about your symptoms and health history. A physical exam will be done. You may need a neurologic exam and an eye exam. You may be sent to a speech-language pathologist, physical or occupational therapists, and genetic counselors.

You may have:

  • Blood tests
  • Urine tests
  • Genetic tests
  • Lumbar puncture
  • Biopsy

The electrical activity of your muscles, nerves, and brain may need to be measured. This can be done with:

  • Electromyography
  • Nerve conduction study
  • Electroencephalography

Pictures may need to be taken of your head. This can be done with:

  • MRI scan
  • CT scan
  • Ultrasound
Electroencephalography
EEG
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Treatments

Treatment

Talk with your doctor about the best plan for you. You may have:

Medications

Your doctor may advise one or more medicines:

  • Over the counter or prescription pain medicine
  • Anticholinergics
  • Benzodiazepines
  • Dopaminergic agents
  • Dopamine-depleting agents
  • Antiseizure medicine

Botulinum Toxin Injections

Injecting botulinum toxin into a muscle can weaken the muscle. This may help you feel better for 3-4 months.

Surgery

Surgery to cut the nerves leading to muscles or removing the muscles may help. Also, surgery to destroy the small site within the brain where dystonia occurs may stop or ease FD.

Deep brain stimulation may also help.

Prevention

FD can’t be prevented. If you take any medicines that may cause FD, talk with your doctor about your risk of getting FD.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.

RESOURCES

Dystonia Medical Research Foundation https://www.dystonia-foundation.org 

International Parkinson and Movement Disorder Society http://www.movementdisorders.org 

CANADIAN RESOURCES

Canadian Movement Disorder Group http://www.cmdg.org 

Health Canada https://www.canada.ca 

References

Carrechio M, Mencacci NE. Emerging monogenic complex hyperkinetic disorders. Curr Neurol Neurosci Rep. 2017;17(12):97.

Cervical dystonia. EBSCO DynaMed Plus website. Available at:  http://www.dynamed.com/topics/dmp~AN~T132176/Cervical-dystonia . Updated April 13, 2017. Accessed June 20, 2018.

Dystonia. International Parkinson Movement Disorder Society website. Available at: http://www.movementdisorders.org/MDS/About/Movement-Disorder-Overviews/Dystonia.htm. Accessed June 20, 2018.

Dystonia. The Canadian Movement Disorder Group website. Available at: http://www.cmdg.org/Movement%5F/dystonia/dystonia.htm. Accessed June 20, 2018.

Gaenslen A. Transcranial sonography in dystonia. Int Rev Neurobiol. 2010;90:179-187.

Meige Syndrome. National Organization for Rare Disorders. Available at: http://rarediseases.org/rare-diseases/meige-syndrome. Accessed July 11, 2013.

Newby RE, Thorpe DE, Kempster PA, Alty JE. A history of dystonia: ancient to modern. Mov Disord Clin Pract. 2017;4(4):478-485.

NINDS dystonias information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/dystonias/dystonias.htm. Updated July 2, 2013. Accessed July 11, 2013.

What is dystonia? Dystonia Medical Research Foundation website. Available at: https://www.dystonia-foundation.org/what-is-dystonia. Accessed July 11, 2013.