Dystonia Treatment
What is dystonia?
It is an involuntary, sustained or intermittent movement with muscle contractions usually causing abnormal postures or movements repetitively. The contraction of agonist and antagonist musculature is common at the same time.
Dystonia can be classified as primary (also called idiopathic when it develops without having a specific cause) or secondary (when it develops after an event such as lack of oxygen in the brain, a stroke, or even after a Primary dystonia can be focal (when restricted to a segment) or generalized. Blepharospasm (blink of the eyes with contraction in the involuntary face) and chronic torticollis are types of focal dystonia.
In children, usually dystonia begins in one limb, it rarely starts on the face or neck. It usually evolves with progressive involvement of more limbs, until it becomes generalized. In adults, dystonia usually starts from the face or neck, and may affect nearby muscles, such as an increase in the dystonic area. Rarely it spreads to the point of becoming a generalized dystonia.
It is important to remember that dystonia is a symptom and not a disease. Diseases with dystonias are complex, poorly understood, and rarely curable. The correct classification of dystonia impacts on:
- Prognosis
- Differential Diagnostics
- Exams to be performed
- Possible treatments
There is an acute state of great worsening in the abnormal movements, called Status Dystonicus or Dystonic Storm. It is a neurological emergency, with crises of frequent and painful contractions, which can lead to metabolic and respiratory complications, and may even lead to death. Dr. Monaco published with the neurosurgery team a case of successfully treating Status Dystonicus with intrathecal infusion of morphine (read more). It is different from Acute Dystonic Reaction, commonly observed in patients who treat Parkinson's Disease with dopaminergic medications.

What are the treatments for dystonia?
There is no effective treatment for dystonia, a cure for such a symptom is unknown. There are treatments that can help in the quality of life, promoting the improvement of the involuntary movements and even making them imperceptible in some cases.
Treatment is usually performed by specialized physicians such as neuropediatricians, neurologists specializing in movement disorders or functional neurosurgeons. It is recommended multidisciplinary treatment, with psychology, speech therapy, occupational therapy, physiotherapy and physical educator. Adjustments in daily life to cope with a motor difficulty are necessary.
Clinically, the treatment can be performed with oral medications, in a step-by-step and individualized way for each patient. In some cases, intrathecal infusion of drugs for treatment (such as the Baclofen Pump) may be used.
For focal dystonias, the application of botulinum toxin type A is a good treatment option and should be performed by experienced professionals, since the musculature may have a variable response to the treatment.
For some types of hyperkinetic dystonias (with frequent involuntary movements), treatment with deep brain stimulation (read more) in different brain targets, considered mainly for primary dystonias, may be considered. In Brazil, ANS ROL provides for the implantation of deep brain stimulation systems in children from 8 years of age. For more information it is suggested that you look for a functional neurosurgeon.
What are the possible causes of secondary dystonias?
The causes of secondary dystonia are: brain demyelinating diseases (such as multiple sclerosis); brain injury due to anoxia, such as cerebral palsy; acute disseminated encephalomyelitis; central nervous system infections; tumors in the central nervous system; vascular lesions in the central nervous system; such as arteriovenous malformations, or cerebrovascular accidents; drugs or medications and brain trauma. There are heredodegenerative diseases of the nervous system that can also occur with dystonia, such as Wilson's Disease, Huntington's Disease, Parkinson's Disease, Parkinsonism (also called Parkinson's), nervous system atrophies, spinocerebellar ataxia type 3, innate errors of metabolism , lipid storage disorders (such as Niemann-Pick disease), mitochondrial diseases, accumulation of metals in the nervous system among others even more rare.

For more information, find your functional neurosurgeon.