Focal dystonia (FD) is an uncontrolled movement problem that happens in one part of the body. A person may have unusual movements, twitches, and tics. It may happen all the time or off and on. The most common types are:
- Blepharospasm—an eye twitch
- Cervical dystonia or spasmodic torticollis—happens to the neck
- Segmental cranial dystonia (Meige syndrome)—happens to the jaw, tongue, and eyes
- Oromandibular dystonia—happens to the jaw
- Spasmodic dysphonia—happens to the vocal cords
- Axial dystonia—happens to the trunk
- Dystonia of the hand/arm, such as writer's cramp
Treatment can help manage FD.
In most people, the cause of FD not known. In others, it may be due to genes.
FD can also be caused by a health problem or injury, such as:
- Reactions to medicines
- Problems during birth, such as lack of oxygen
- Heavy metals in the body
- Carbon monoxide poisoning
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FD is more common in people who have family members who have it.
It is also more common in people who have a health problem or injury that raises the risk.
Symptoms of FD may be:
- Eyelid spasms
- Fast or uncontrollable blinking of both eyes
- Neck twisting
- Problems writing
- Foot cramps
- Pulling or dragging of a foot
- Problems speaking
FD may get worse with:
- Being tired
The doctor will ask about symptoms and past health. A physical exam will be done. The person may be sent to doctor who treats the nervous system. A neurologic exam may be done.
There are no tests to confirm FD. These tests may be done to rule out other problems:
- Lab tests, such as blood, urine, and genetic testing
- Lumbar puncture—to look at the fluid surrounding the brain and spine
The electrical activity of the muscles, nerves, and brain may need to be measured. This can be done with:
Pictures may be taken of the head with:
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The goal of treatment is to manage symptoms. Options are:
- Botulinum toxin injected into a muscle—to weaken the muscle
- One or more medicines, such as:
- Over the counter or prescription pain medicine
- Dopaminergic agents
- Dopamine-depleting agents
- Antiseizure medicine
Surgery may be done to:
- Cut the nerves leading to muscles, or to remove the muscles
- Destroy the small site within the brain where dystonia occurs
- Implant electrodes in the brain—to control muscle movements
There are no known guidelines to prevent focal dystonia.
- Carrechio M, Mencacci NE. Emerging monogenic complex hyperkinetic disorders. Curr Neurol Neurosci Rep. 2017;17(12):97.
- Cervical dystonia. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/cervical-dystonia.
- Dystonia. The Canadian Movement Disorder Group website. Available at: http://www.cmdg.org/Movement_/dystonia/dystonia.htm.
- Dystonia. International Parkinson Movement Disorder Society website. Available at: http://www.movementdisorders.org/MDS/About/Movement-Disorder-Overviews/Dystonia.htm.
- Dystonias fact sheet. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/dystonias-fact-sheet.
- Meige Syndrome. National Organization for Rare Disorders. Available at: http://rarediseases.org/rare-diseases/meige-syndrome.
- Newby RE, Thorpe DE, et al. A history of dystonia: ancient to modern. Mov Disord Clin Pract. 2017;4(4):478-485.
- What is dystonia? Dystonia Medical Research Foundation website. Available at: https://www.dystonia-foundation.org/what-is-dystonia.
- Daniel A. Ostrovsky, MD
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