Dystonia

Suketu M. Khandhar, MD, Medical Director, KPNC Comprehensive Mvt Disorders Program

We all know that the cardinal motor symptoms of PD are resting tremor, rigidity and bradykinesia (slowed movements). But did you know they are not the only motor symptoms patients may experience? What about Dystonia? Dystonia is a sustained muscle contraction causing abnormal postures and positions. It is more than simple muscle cramping. There is a pattern to these movements and they occur in specific areas of the body. For example a common form of dystonia is Cervical Dystonia, previously called Spasmodic Torticollis. It occurs when neck muscles contract involuntarily causing the head to turn or twist to one side. This can happen in isolation or in specific conditions like PD. It most commonly happens when dopaminergic medications wear off. It can be painful. It can interfere with daily activities. Imagine this happening when someone is driving. They would not be able to keep their head looking straight to drive safely.

There are other common forms of dystonia in PD

1. Toe Curling Dystonia – this commonly occurs in the early hours of the day before meds have a chance to kick in

2. Foot Inversion Dystonia – this is where the whole foot turns inward making it difficult to walk with surefootedness.

3. Truncal Dystonia – this is where the torso leans or is pulled to one side.

4. Writer’s Cramp

5. Facial Dystonia – this includes jaw clenching.

6. Blepharospasm – excessive eyelid blinking or forced eyelid closure.

So how do we identify and confirm this condition? A neurologist best identifies Dystonia. There is no blood test or imaging study to help confirm a diagnosis. It relies on taking a good history and clinical examination. Often times however, the dystonia may not be present when in the doctor’s office. I recommend video-recording symptoms in advance in order for the neurologist to review and consider treatment.

Dystonia is best treated by:

1. Reviewing one’s medications to see if any adjustment could improve symptoms.

2. Considering adding or increasing PD medications.

3. Considering muscle relaxants

4. Physical Therapy to relax and stretch the affected muscles.

5. Injecting Botulinum Toxin into the affected muscles – this is a chemical toxin that reduces the transmission between nerve muscle, thereby weakening muscles.

If you think you may have Dystonia, please discuss your symptoms and concerns with your neurologist.