Dystonia

Dystonia may be caused by a genetic mutation (this is called inherited dystonia) or it’s cause may be unknown (idiopathic dystonia). It can also be a side effect of a medication or a symptom of another movement disorder like Parkinson’s disease (acquired dystonia).

Dystonia may affect one or more parts of the body:

• Focal dystonia affects one body part, like the neck. This is the most common subtype in adults.
• Segmental dystonia affects two or more connected parts, like the neck and face.
• Multifocal dystonia affects two or more non-connected parts, like the right hand and left foot.
• Hemidystonia affects one side of the body.
• Generalized dystonia affects most of the body.

Specific types of focal dystonias include:

• Blepharospasm: eyes
• Cervical dystonia: neck
• Focal limb dystonia: arms or legs
• Oral mandibular dystonia: mouth, jaw, and lower face
• Spasmodic dysphonia: larynx (voice box)

Duke movement disorder specialists use a comprehensive approach to identify the causes of your dystonia, tailored to your particular circumstances.

History and Physical Exam
Your doctor will ask about your symptoms, medical history, and family history. They will perform a thorough physical exam, a neurological exam, and may ask you to do certain tasks (like writing or exercising) that could trigger abnormal movements.

Blood and Urine Tests 
Measuring vitamin and mineral levels in your blood and/or urine can help rule out metabolic problems, toxins, or other causes for your symptoms.

Imaging Scans
MRI or CT scans can reveal brain lesions, tumors, and evidence of past strokes.

Electromyography (EMG)
Electromyography measures electrical activity in your muscles. Techniques include nerve conduction studies in which electrodes are placed on the skin to stimulate nerves, as well as needle electromyography, which requires inserting thin, needle-like probes into the muscle.

Genetic Testing 
Testing blood samples can identify specific genes that are associated with dystonia.

Physical Therapy and Occupational Therapy
Highly trained therapists help you optimize functional mobility and increase range of motion based on the latest advances and a thorough understanding of dystonia.

Speech Therapy
Speech-language pathologists help you compensate for changes in speech and communication that occur with certain types of dystonia.

Medications 
Medications help suppress symptoms of dystonia. For example, the brain chemicals dopamine and acetylcholine are involved in the brain circuits that regulate movement. Many dystonias respond to drugs that reduce acetylcholine, and some dystonias respond well to increasing dopamine. Other types of medications relax muscles to reduce symptoms.

Injections
Injections of botulinum toxin into certain muscles can reduce abnormal movements, muscle spasms, or pain. Our movement disorder specialists are trained to recognize specific muscles that may be driving abnormal dystonic movements or postures.

Deep Brain Stimulation (DBS)
A deep brain stimulator is a surgically implanted device that uses electrical impulses to disrupt abnormal brain activity. Deep brain stimulation can significantly improve symptoms associated with certain types of dystonia. DBS may be an option for you if medication and/or injections have not been effective, or if you experience serious side effects from medications.

Dystonia Center of Excellence
Duke is one of only two dystonia centers of excellence designated by Tyler’s Hope for a Dystonia Cure Foundation. This designation recognizes Duke’s delivery of high-quality inter-disciplinary dystonia care, research efforts, and training program to help others recognize and treat dystonia, discover better treatments, and work toward a cure.

Team Approach
Our comprehensive team of dystonia providers includes specially trained neurologists, neurosurgeons, ophthalmologists, otolaryngologists, and others who have experience diagnosing and treating dystonia. We work together to care for people with movement disorders and support and educate their families.

Clinical Research
Duke experts lead research studies to find novel ways to treat dystonia. For example, our doctors are studying transcranial magnetic stimulation, which shows promise as a new treatment for dystonia. As a Duke patient, you may be able to participate in clinical trials and receive new treatments before they are widely available.

Support Group 
We offer a patient-led support group for people with dystonia and their caregivers. The group meets monthly and participates in annual dystonia events.