Dystonia

Question 1

Dystonias are?

Answer 1

sustained or intermittent abnormal repetitive movements or postures due to alterations in muscle tone.

The dystonia spasms may affect:

1. one (focal) e.g. blepharospasm of eyelid
2. more parts of the body (segmental) e.g. neck—spasmodic torticollis
3. the whole body (generalised) e.g. oculogyric crisis

Question 2

Generalised dystonia

Answer 2

Usually drug induced, e.g. levodopa, psychotropics.

Treatment: benztropine 1–2 mg IM or IV

Question 3

Focal dystonias

Answer 3

Blepharospasm (uncontrolled blinking)

Oromandibular (jaw grinding and grimacing)

Meige’s syndrome (combination of above two)

Hemifacial spasms (eye spreading to face): related to facial nerve irritation

Cervical dystonia (spasmodic torticollis)

Laryngeal or spastic dystonia—strained hoarse voice

Hand and forearm cramps (e.g. writer’s, typist’s, golfer’s or pianist’s cramps)

Question 4

Treatment of focal dystonias

Answer 4

Injection of purified botulinum A toxin into affected muscle groups

• —with care.

Usually repeated every 3–6 mths.