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Definition

Focal dystonia (FD) is a 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, also known as 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

Causes

In most people, the cause is not known. In others, it may be due to genes.

FD can also be caused by a health problem or injury, such as:

The Process of Carbon Monoxide Poisoning Decreasing Available Oxygen
Carbon monoxide poisoning

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Risk Factors

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

Problems may be:

  • Eyelid spasms
  • Rapid or uncontrollable blinking of both eyes
  • Neck twisting
  • Problems writing
  • Foot cramps
  • Pulling or dragging of a foot
  • Shaking
  • Problems speaking

FD may get worse with:

  • Excitement
  • Stress
  • Talking
  • Being tired

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. You may be sent to see a 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. This can be done with:

Electroencephalography
EEG

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Treatment

The goal of treatment is to manage symptoms. Options are:

Medications

The doctor may give one or more medicines:

  • Over the counter or prescription pain medicine
  • Anticholinergics
  • Benzodiazepines
  • Dopaminergic agents
  • Dopamine-depleting agents
  • Antiseizure medicine

Botulinum Toxin Injections

Injecting botulinum toxin into a muscle can weaken the muscle. The effect may last for 3 to 4 months.

Surgery

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

Prevention

There are no known guidelines to prevent this health problem.

RESOURCES:

Dystonia Medical Research Foundation
https://www.dystonia-foundation.org

International Parkinson and Movement Disorder Society
http://www.movementdisorders.org

CANADIAN RESOURCES:

Canadian Movement Disorder Group
http://www.cmdg.org

Health Canada
https://www.canada.ca

REFERENCES:

Albanese A, Bhatia K, et al. Phenomenology and classification of dystonia: a consensus update. Mov Disord. 2013 Jun 15;28(7):863-873.

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. Accessed October 22, 2020.

Dystonia. The Canadian Movement Disorder Group website. Available at: http://www.cmdg.org/Movement_/dystonia/dystonia.htm. Accessed October 22, 2020.

Dystonia. International Parkinson Movement Disorder Society website. Available at: http://www.movementdisorders.org/MDS/About/Movement-Disorder-Overviews/Dystonia.htm. Accessed October 22, 2020.

Dystonias information page. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Dystonias-Fact-Sheet. Accessed October 22, 2020.

Meige Syndrome. National Organization for Rare Disorders. Available at: http://rarediseases.org/rare-diseases/meige-syndrome. Accessed October 22, 2020.

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. Accessed October 22, 2020.

Last reviewed September 2020 by EBSCO Medical Review Board Daniel A. Ostrovsky, MD  Last Updated: 5/18/2021