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More on Dystonia
More on Dystonia
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Neurology and Neuroscience
Dystonia is a syndrome of abnormal, involuntary muscle contractions that cause twisting and repetitive movements of the affected body parts. People experience the symptoms in their muscles, but the underlying problem is the abnormal activation of cells in the brain. Dystonia is the third most common movement disorder after essential tremor and Parkinson's disease, and affects more than 300,000 people in North America. It is caused by a combination of genetic and environmental factors.
Dystonia may affect a single part of the body, several body parts, or the entire body. Some forms of dystonia impair only the performance of a specific task, such as writing or playing a musical instrument.
When a single body part is affected by dystonia, the condition is referred to as focal dystonia. Common forms of focal dystonia affect the:
- Neck (cervical dystonia or spasmodic torticollis)
- Eyelids (blepharospasm)
- Voice (spasmodic dysphonia)
- Hand (writer's cramp)
- Well-practiced muscles of professional musicians (musicians' dystonia)
Focal dystonia may spread to adjacent body parts (segmental dystonia) or unrelated parts of the body (multifocal dystonia). In children, dystonia often begins in a limb and spreads to involve one or both legs, the trunk, and other parts of the body; this is referred to as generalized dystonia.
Diagnosis of Dystonia
Doctors in the NewYork-Presbyterian Hospital department of neurology have extensive experience in the diagnosis and treatment all forms of dystonia. They work closely with each patient to develop a customized treatment approach.
Our physicians also have specific expertise in treating performing artists who develop dystonia and other movement disorders. At NewYork-Presbyterian's Weill Cornell Medical Center campus, this is done through the Center for the Performing Artist at Weill-Cornell.
Medical Treatment for Dystonia
Treatment for dystonia is directed toward decreasing muscle spasms, pain, and awkward postures, and improving patients' quality of life. Doctors may try a number of different treatments or combination of treatments before finding the therapy that is most effective for each patient.
Oral medications for dystonia include those that affect the neurotransmitter chemicals involved in the control of muscle movement. These medications may include agents that modulate the levels of acetylcholine, dopamine, or GABA, three brain chemicals that are important for producing normal movement.
Our neurologists also treat dystonia with botulinum toxin therapy, a safe and effective treatment that can relax dystonic muscles for several months, allowing patients to maintain a more normal posture and movement. We collaborate with members of the Department of Otorhinolaryngology (Ear, Nose, and Throat) to provide botulinum treatment for people with spasmodic dysphonia.
Surgical Treatment for Dystonia
Deep Brain Stimulation (DBS)
Deep brain stimulation (DBS), a surgical procedure pioneered at NewYork-Presbyterian Hospital, has become an important tool in the treatment of dystonia. In the procedure, neurosurgeons permanently implant a device into the brain that acts like a pacemaker. The device reduces abnormal brain activity in dystonia, thereby minimizing dystonic spasms. DBS also enables many patients to reduce their dependence on medications, which over time may cause unpleasant side effects.
Doctors here take special precautions during brain surgery. NewYork-Presbyterian Hospital maintains the most advanced intraoperative neurophysiological monitoring system worldwide. Continuously monitoring the electrical activity of the brain and spinal cord during surgery diminishes the risk of neurological injury.
Rehabilitation for Dystonia
Physical, occupational, speech, and nutrition therapy can all be helpful to patients with dystonia. Adaptive and augmentative equipment can help patients communicate effectively, remain mobile, and ensure their safety. Rehabilitation specialists will:
- Evaluate muscle strength and motor skills and develop an individualized program to maintain existing motor function.
- Recommend devices including neck supports, canes, walkers, and wheelchairs and equipment for the home to ensure patient safety and mobility.
- Discuss ways to modify activities, conserve energy, and simplify work.
Some patients with dystonia find that complementary therapies such as yoga, meditation, Pilates, biofeedback, and acupuncture are also helpful.
Research for Dystonia
Researchers at Columbia's Center for Parkinson's Disease and Other Movement Disorders and Weill Cornell's Parkinson's Disease and Movement Disorders Institute are conducting studies to identify the causes of dystonia, treat the disease, and improve care and management.
Patients treated at our movement disorders centers also have access to the extensive clinical resources of NewYork-Presbyterian Hospital.