Dystonia is a movement disorder that causes muscles to contract uncontrollably and lead to abnormal postures. Dystonia affects about 1% of the population and is more common in women than men. Dystonia can affect different body parts and often the symptoms of dystonia progress through stages.  

Overview and Symptoms

Some early symptoms include:

  • Turning or dragging of the leg and foot
  • Cramping of the foot
  • Involuntary turning and pulling of the neck
  • Uncontrollable blinking
  • Speech difficulties
  • Worsening handwriting
  • Tremor
  • Pain
  • Walking difficulties
  • Functional impairment
  • Poor quality of life

To diagnose dystonia, your doctor will start with a medical history and physical examination. Your doctor will also take into consideration when your symptoms started, the order in which your symptoms developed, and the speed at which your symptoms are progression. To determine if underlying conditions are causing your symptoms, your doctor might recommend:

  • Blood or urine tests to look for signs of toxins or of other conditions.
  • MRI or CT scan to help identify abnormalities in your brain, such as tumors, lesions or evidence of a stroke.
  • Electromyography (EMG), a test that measures the electrical activity within muscles.

Treatment

Dystonia may be treated with a combination of medication, botulinum toxin injections, speech therapy, physical therapy, and/or stress management.  Our movement disorder specialists, Dr. Samuel Frank and Dr. Lan Luo are also experts on botulinum toxin injections for dystonia.  When considering botulinum toxin injection as a treatment for dystonia, it is extremely important to be evaluated and injected by a specialist trained in this procedure in order to obtain the best possible outcome.  The art of botulinum toxin injection requires careful selection of the type of toxin, the amount of botulinum toxin, and the muscles involved in the dystonia.

If the above approaches do not offer adequate improvement, then globus pallidus (GPi) deep brain stimulation (DBS), or surgical implantation of electrodes into a region of the brain called globus pallidus may be offered.  At our center, Dr. Michael Fox and Dr. Lan Luo are experts in selecting patients for DBS surgery and programming the DBS device after surgery.  If a patient is a candidate for DBS, we will use a multidisciplinary approach consisting of our movement disorder specialists (Dr. Michael Fox and Dr. Lan Luo), our neurosurgeon (Dr. Ron Alterman), our neuropsychologist (Dr. George Lin), our DBS coordinator (Ms. Sandrine Jabbour), our social worker (Ms. Lissa Kapust) to guide you throughout every step of the process.  This treatment requires frequent follow-up visits for the first three months after surgery for the physician to adjust the settings on the device to provide the maximum benefit.  You may also have the option of transcranial magnetic stimulation (TMS), a neurophysiological technique that allows the induction of a current in the brain using a magnetic field to pass the scalp and the skull safely and painlessly.

Learn More

The Department of Neurology provides a full range of both inpatient and outpatient neurological services through a variety of subspecialty clinics, including Cognitive Neurology, Epilepsy, Stroke, Neuromuscular Disease, Parkinson's Disease and Movement Disorders, Neuro-ophthalmology, Neuro-oncology, Neuro-HIV, Neurogenetics, Multiple Sclerosis, and Sleep Disorders.

Visit Neurology