Tag Archives: Spasm

Dystonia

Definition:
Dystonia is a syndrome of spasms and sustained contractions of the muscles. These muscle movements are not under voluntary control and they result in repetitive abnormal movements of parts of the body or persistently abnormal postures.

CLICK & SEE THE PICTURES

Dystonia is a movement disorder which causes involuntary contractions of your muscles. These contractions result in twisting and repetitive movements. Sometimes they are painful.

Dystonia can affect just one muscle, a group of muscles or all of your muscles. Symptoms can include tremors, voice problems or a dragging foot. Symptoms often start in childhood. They can also start in the late teens or early adulthood. Some cases worsen over time. Others are mild.

Some people inherit dystonia. Others have it because of another disease. Either way, researchers think that a problem in the part of the brain that handles messages about muscle contractions might cause dystonia. There is no cure. Instead, doctors use medicines, surgery, physical therapy and other treatments to reduce or eliminate muscle spasms and pain.

Dystonia is incurable  thought to affect at least 40,000 people in the UK.

The different types of dystonia include:

•Cervical dystonia (spasmodic torticollis) affects the neck muscles, causing the head to twist, pull in one direction or shake
Blepharospasm – dystonia of the muscles around the eyes
Oromandibular dystonia – affecting the muscles of the jaw, tongue and mouth
•Laryngeal dystonia – affecting the speech muscles
Writer’s cramp – affecting the ability to write and sometimes other hand-based tasks
There are several types of dystonia that affect more than one area of the body including generalised dystonia, which affects most of the body, frequently involving the legs and back (trunk).

If dystonia develops in childhood, particularly if it starts in the legs, it may spread to other parts of the body and can become generalised. However, when it develops in adults, it usually confines itself to one part of the body (focal dystonia).

Although dystonia is a neurological disorder, it does not lead to problems with other functions of the brain, such as intellect.

It occurs in all parts of the world and affects people of all ages.

Dystonia can affect virtually any single part of the body or several different areas at once.

Classification:

Types of dystonia
*Generalized
*Focal
*Segmental
*Sexual
*Intermediate
*Acute Dystonic Reaction

Generalized dystonias:
*Normal birth history and milestones
*Autosomal dominant
*Childhood onset
*Starts in lower limbs and spreads upwards
*Also known as “idiopathic torsion dystonia” (old terminology “dystonia musculrum deformans”)

Focal dystonias:
These are the most common dystonias and tend to be classified as follows:
*Anismus…. muscles of the rectum……… Causes painful defecation, constipation; may be complicated by encopresis.

*Cervical dystonia (spasmodic torticollis)…. muscles of the neck…. Causes the head to rotate to one side, to pull down towards the chest, or back, or a combination of these postures.

*Blepharospasm…. muscles around the eyes The sufferer experiences rapid blinking of the eyes or even their forced closure causing effective blindness.

*Oculogyric crisis.. muscles of eye and head….An extreme and sustained (usually) upward deviation of the eyes often with convergence causing diplopia. It is frequently associated with backwards and lateral flexion of the neck and either widely opened mouth or jaw clenching. Frequently a result of antiemetics such as the neuroleptics (e.g., prochlorperazine) or metoclopramide. Also can be caused by Chlorpromazine.

*Oromandibular dystonia….muscles of the jaw and muscles of tongue……Causes distortions of the mouth and tongue.

*Spasmodic dysphonia/Laryngeal dystonia…muscles of larynx…..Causes the voice to sound broken or reducing it to a whisper.

*Focal hand dystonia (also known as musician’s or writer’s cramp)…..single muscle or small group of muscles in the hand…..It interferes with activities such as writing or playing a musical instrument by causing involuntary muscular contractions. The condition is sometimes “task-specific,” meaning that it is generally only apparent during certain activities. Focal hand dystonia is neurological in origin, and is not due to normal fatigue. The loss of precise muscle control and continuous unintentional movement results in painful cramping and abnormal positioning that makes continued use of the affected body parts impossible.
Symptoms:
The progress of dystonia is unpredictable.

The severity of symptoms can vary from day to day, and while there often is an element of overall progression, it is difficult to estimate how long this will last.

Typically, a focal dystonia will progress gradually over a five-year period, and then progress no further.

Symptoms in all dystonic conditions can vary.

For some people, their dystonia may sometimes improve or disappear altogether for no apparent reason.

As with the onset of any long-term medical condition, some people who develop dystonia may go through an initial period of depression, embarrassment and outrage – or relief that there is an explanation for their symptoms.

 

Causes:
Dystonia is a movement disorder. Although the causes of dystonia are not fully known it is currently thought that the condition results from a malfunction in a part of the brain called the basal ganglia.

The basal ganglia are structures situated deep in the brain. They help to regulate voluntary and involuntary movement by controlling muscle contractions in the body.

The problem may mainly lie in an area of the basal ganglia called the globus pallidus. If this area of the brain is not functioning correctly then the control of another structure in the brain called the thalamus is affected.

The thalamus controls the planning and execution of movement and sends nerves to muscles via the spinal cord. The end result is that muscle co-ordination is not regulated properly. The wrong muscles will contract on movement or all muscles will contract unnecessarily causing abnormal movement and posture.

Muscles positioned around joints usually work in pairs opposite each other, eg the biceps and triceps muscles of the upper arm bend or straighten the elbow respectively. Usually if one muscle of a pair is contracted the other is relaxed. However, in dystonia both muscles in the pair contract at the same time leading to the abnormal movement or posture.

It is thought that in some cases there may be a chemical imbalance or ‘wiring fault’ in the basal ganglia. Chemical transmitters, such as dopamine, convey messages from one nerve cell to another within the basal ganglia. If this balance is upset then incorrect signals will be sent out resulting in loss of regulation of co-ordinated movements.

Supporting this theory is the fact that people with dystonia do not show structural abnormalities of the brain. The ‘wiring fault’ theory is therefore more likely because it works at a much smaller scale.

The fault in the basal ganglia may be caused by an inherited factor or be secondary to another problem such as drugs or toxins, or a separate neurological disease. Recently scanning studies using positron emission tomography (PET) in patients with cervical (neck muscle) dystonia have revealed reduced basal ganglia density of an important dopamine receptor (the D2 receptor).

Genetic risk factors:
Dystonia that develops in childhood is often inherited through one or more affected genes.

Most primary segmental or generalised dystonia is inherited in a dominant manner, which means if a parent has this type of dystonia, there’s a 50% chance of passing the dystonia gene to each child.

However, not everyone who inherits the gene develops dystonia, a phenomenon known as reduced penetrance.

Dystonia which develops in adults may also be inherited.

 

Diagnosis:
There is no definitive test for dystonia. Diagnosis depends on the presence of characteristic clinical symptoms and signs. The neurologist will perform a full neurological examination and may also perform blood tests or a brain scan to rule out an illness or injury that may be causing the dystonia. If no cause can be found the dystonia is termed ‘idiopathic’.

Treatment:
There is no cure for most forms of dystonia. However, many dystonic conditions can be successfully managed.

Most people manage to develop effective strategies for coping with the challenges their condition brings.

Successful treatments to lessen their symptoms, effective pain control and the acquisition of sensory ‘tricks’ all help to ameliorate social situations.

Various treatments are available for dystonia. These will be determined depending upon the type and severity of the particular condition.

The main options are:
•Botulinum toxin – injections are generally the most effective treatment for dystonia where it affects the muscles of the neck or around the eyes. However, resistance to botulinum toxin can develop in a minority of patients over time.
•Drugs – some work by interfering with neurotransmitters, the chemical substances that carry messages within the brain, while others are designed to relax the muscles, reducing shaking and control muscle spasms. To be effective, they have to be taken continuously.
•Surgery – may be an option where patients have never been or are no longer receptive to other treatments. Treatments include selective denervation and deep brain stimulation (DBS). In the case of the latter, electrodes are planted in the basal ganglia to help rebalance movement and control posture. Recent research has led to a refinement in the placing of electrodes for optimum effect.

Other treatment:
Physical therapies such as physiotherapy with ice, heat or ultrasound, speech therapy for spasmodic dysphonia, acupuncture, osteopathy or chiropractic techniques help some patients. However, treatments involving manipulation of the neck are not recommended for spasmodic torticollis. Relaxation therapies such as hypnosis, behaviour therapy, biofeedback and meditation may also help.

Good advice:
A positive attitude is vital. Dystonia is not life-threatening but can be disabling. Dystonia can have a profound effect both emotionally and functionally. Sufferers should try to continue to lead as normal a life as possible. Counselling and family and social support is helpful.

Many patients with focal dystonias such as torticollis can control the abnormal posture for a short time by using sensory tricks or ‘gestes antagonistiques’. The most common geste is to place a finger or hand against the lower face on the same or opposite side to the direction of movement. Other gestes include sucking a pen or necklace or pulling on the end of the nose or an earlobe. Ambient sound has also been found to relieve dystonia.

Prognosis:
Focal dystonias such as torticollis and blepharospasm may worsen over several years before stabilising. They may improve or disappear for no apparent reason. The likelihood of this has been estimated from anything from 1 in 10 to 1 in 20, but there is no way to predict whether it will happen. In some cases the dystonia will return after a period of remission, but other patients can remain symptom free for the rest of their lives.

Focal dystonias are unlikely to spread to become generalised dystonia. However, some focal dystonias may be associated with each other.

If the dystonia develops in childhood then it usually spreads to other parts of the body and becomes generalised. This type of dystonia is much more disabling than the adult focal type.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/dystonia.shtml
http://en.wikipedia.org/wiki/Dystonia
http://www.nlm.nih.gov/medlineplus/dystonia.html#cat5
http://www.netdoctor.co.uk/diseases/facts/dystonia.htm

Enhanced by Zemanta
Advertisements

Blepharospasm

Definition:
Benign essential blepharospasm (BEB) is a progressive neurological disorder characterized by involuntary muscle contractions and spasms of the eyelid muscles. It is a form of dystonia, a movement disorder in which muscle contractions cause sustained eyelid closure, twitching or repetitive movements. BEB begins gradually with increased frequency of eye blinking often associated with eye irritation.

CLICK & SEE
click to see the picture
Benign means the condition is not life threatening. Essential indicates that the cause is unknown, but fatigue, stress, or an irritant are possible contributing factors. Symptoms sometimes last for a few days then disappear without treatment, but in most cases the twitching is chronic and persistent, causing lifelong challenges. The symptoms are often severe enough to result in functional blindness. The person’s eyelids feel like they are clamping shut and will not open without great effort. Patients have normal eyes, but for periods of time are effectively blind due to their inability to open their eyelids.

Although strides have recently been made in early diagnosis, blepharospasm is often initially mis-diagnosed as allergies or “dry eye syndrome“. It is a fairly rare disease, affecting only one in every 20,000 people in the United States.


Symptoms:

*Excessive blinking and spasming of the eyes, usually characterized by uncontrollable eyelid closure of durations longer than the typical blink reflex, sometimes lasting minutes or even hours.
click for the picture
*Uncontrollable contractions or twitches of the eye muscles and surrounding facial area. Some sufferers have twitching symptoms that radiate into the nose, face and sometimes, the neck area.

*Dryness of the eyes

*Sensitivity to the sun and bright light

click to see the picture
Causes:

Some causes of blepharospasm have been identified; however, the causes of many cases of blepharospasm remain unknown, although some educated guesses are being made. Some blepharospasm patients have a history of dry eyes and/or light sensitivity, but others report no previous eye problems before onset of initial symptoms.

Some drugs can induce blepharospasm, such as those used to treat Parkinson’s disease, as well as sensitivity to hormone treatments, including estrogen-replacement therapy for women going through menopause. Blepharospasm can also be a symptom of acute withdrawal from benzodiazepine dependence. In addition to blepharospasm being a benzodiazepine withdrawal symptom, prolonged use of benzodiazepines can induce blepharospasm and is a known risk factor for the development of blepharospasm.

Blepharospasm may also come from abnormal functioning of the brain basal ganglia. Simultaneous dry eye and dystonias such as Meige’s syndrome have been observed. Blepharospasms can be caused by concussions in some rare cases, when a blow to the back of the head damages the basal ganglia.

Blepharospasm often occurs out of the blue for no specific reason. Rarely, it can run in families.

Diagnosis:
The diagnosis of blepharospasm depends on recognition of its characteristic features by an expert, such as a neurologist or ophthalmologist. There are no medical tests for proving the diagnosis, but some tests may be conducted to rule out other possible problems. These may include tests for allergies or dry eyes or scans of the brain.


Treatment:

*Drug therapy: Drug therapy for blepharospasm has proved generally unpredictable and short-termed. Finding an effective regimen for any patient usually requires trial and error over time. In some cases a dietary supplement of magnesium chloride has been found effective.

*Botulinum toxin injections (Botox is a widely known example) have been used to induce localized, partial paralysis. Among most sufferers, botolinum toxin injection is the preferred treatment method.[3] Injections are generally administered every three months, with variations based on patient response and usually give almost immediate relief (though for some it may take more than a week) of symptoms from the muscle spasms. Most patients can resume a relatively normal life with regular Botulinum toxin treatments. A minority of sufferers develop minimal or no result from Botox injections and have to find other treatments. For some, Botulinum toxin diminishes in its effectiveness after many years of use. An observed side effect in a minority of patients is ptosis or eyelid droop. Attempts to inject in locations that minimize ptosis can result in diminished ability to control spasms.

*Surgery: Patients that do not respond well to medication or botulinum toxin injection are candidates for surgical therapy. The most effective surgical treatment has been protractor myectomy, the removal of muscles responsible for eyelid closure.

*Dark glasses are often worn because of sunlight sensitivity, as well as to hide the eyes from others.

*Stress management and support groups can help sufferers deal with the disease and prevent social isolation.

Prognosis:

With botulinum toxin treatment most individuals with BEB have substantial relief of symptoms. Although some may experience side effects such as drooping eyelids, blurred or double vision, and eye dryness, these side effects are usually only temporary.

Researches:
The NINDS supports a broad program of research on disorders of the nervous system, including BEB. Much of this research is aimed at increasing understanding of these disorders and finding ways to prevent, treat, and cure them.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Blepharospasm
http://www.ninds.nih.gov/disorders/blepharospasm/blepharospasm.htm
http://www.bbc.co.uk/health/physical_health/conditions/blepharospasm1.shtml
http://www.nature.com/eye/journal/v18/n3/fig_tab/6700624f1.html
http://microbewiki.kenyon.edu/index.php/File:Botwoman.jpg
http://rarediseasesnetwork.epi.usf.edu/dystonia/patients/learnmore/craniofacial/

http://www.graphicshunt.com/health/images/blepharospasm-608.htm

Enhanced by Zemanta

Natural Remedies of Aching Muscles

If you are like millions of Americans who are constantly roused from a peaceful slumber with painful muscle cramps, backaches and stiff joints, then you know the agony these conditions can bring.

……………..click & see

Instead of turning to those toxic pills, creams and solutions that can do more harm than good, reach for a combination of these essential ingredients and feel the difference these all-natural remedies can have on your strained muscles and over-worked joints:

Aloe Barbadensis Leaf Juice
—This flowering plant contains key substances like aloenin, magnesium lactate, barbaloin and succinic acid, which all may help reduce inflammation.

Camphor—This ancient herbal remedy has been used for centuries to treat minor sprains and muscle inflammation by acting like an anesthetic and antimicrobial substance.

Methylsulfonylmethane (MSM)—This essential ingredient can help increase blood supply, relieve muscle spasms, soften scar tissue and reduce inflammation.

Eucalyptus Oil—This fragrant extract has been used for centuries to ease minor pain in muscles and joints. This remarkable nutrient also has strong antiseptic and disinfectant properties.

Vitamin E—This essential vitamin has been shown to help relieve minor muscle and joint pain associated with cramps.

Methyl SalicylateThis fragrant extract from the leaves of the wintergreen tree relaxes your muscles and eases your minor joint pain. This cooling analgesic was first used by native people as a poultice for overtaxed muscles, minor joint pain, minor strains and sprains.

Menthol
—This pungent ingredient is found in peppermint oil and has been used for centuries to relieve minor muscle aches, sprains and similar muscle problems.

By adding these safe and effective solutions to your treatment regimen you can finally say goodbye to your muscle strains, backaches, joint pain and inflammation once and for all. Plus, after enjoying everyday activities again you can rejoice knowing you’ll get a good night’s rest, too!

Source:    http://www.betterhealthresearch.com/health-articles/soothe-your-aching-muscles-with-these-all-natural-remedies/

Reblog this post [with Zemanta]

Ankle Sprain? Fret not

Ankle joints, undependable as they are, can easily slip. As joints they are fragile, and, unlike the hip, are not surrounded by protective strong muscles. Instead the bones are held in place by ligaments — the rope-like ends of muscles — that are not as strong. They are also more prone to displacement, stretching and tears. This means around 25,000 people sprain their ankles every day just in the US.
CLICK & SEE THE PICTURES
The ankle is a hinge joint, meant to move upwards and downwards. If torsion or twisting movement occurs accidentally, the ligaments fail to hold. The ankle can then be forced out of its normal position. As the body is unprepared, the joint can “give way” resulting in a sprain.

The entire weight of the body rests on this weak pair of ankle joints. Acute injury usually means that the person either falls or hobbles away painfully.

Age is no bar, and both the young and old can “sprain” their ankles. An ankle sprain is more likely to occur if:

• The footwear is unsuitable, with hard unyielding soles, or spiky or rocker-bottom heels.

The foot is placed awkwardly while landing after a jump.

• A fall causes the ankle to twist.

• One walks or exercises on an uneven surface resulting in loss of balance.

• A person is overweight.

• The ankle has been injured before and is unstable, causing a repetition of the injury.

If the sprain is mild, after a few painful minutes it is possible to put the foot back on the ground and walk. With a more severe injury, the foot may be swollen. There may be a bluish red discolouration over the joint. Weight bearing may cause such excruciating agony that it is impossible to walk. If there is a popping sound or weight bearing is impossible, the ligament may have been torn. In the process, a small piece of bone may have been dislocated or chipped off.

In many mild sprains “home remedies” work wonders. This consists of PRICE — Protection, Rest, Ice Compression and Elevation:

• Immediately apply ice. It reduces the swelling and inflammation, reduces muscle spasm and numbs pain.

• Protect the joint from further dislocation with elastocrepe bandages and an ankle support. These are available in medical stores.

• Avoid bearing weight by using a crutch or leaning on a cane.

• Rest as much as possible.

• Elevate the leg so that the ankle is above the level of the heart. Keep it like that as long as possible. This will reduce the swelling.

• Take mild painkillers like Aspirin, or NSAIDs (non-steroidal anti-inflammatory agents) like Ibuprofen.

If the sprain is mild, with these measures the pain will disappear in three days. If discomfort persists, it is better to consult a physician, as the ligaments may be torn or the bone chipped. An X-ray or a scan may be needed to evaluate the joint.

The first stage of recovery takes around a week. The ankle should be rested as much as possible. For the next two weeks, passive exercises should be done to increase the strength and restore flexibility. This is very important because if the ligaments are not moved they can become stiff and fixed.

Plaster of Paris (POP) can be applied as a cast if the sprain is severe. It keeps the joint fixed and helps rapid recovery. Casts can also be made with new lightweight materials and fitted to facilitate walking.

Surgery is rarely required, but can be performed if pain and instability persist after months of using elastocrepe bandages and exercises. Arthroscopy can be done with a scope to visualise the joint and remove any loose fragments of bone or cartilage. If the ligaments are badly damaged, reconstruction of the joint can be undertaken.

Athletes sometimes tape their ankles or wear an elastic guard prior to exercise to prevent a sprain from occurring. This is not effective unless the joint is already known to be unstable.

If the sprain is unrecognised or neglected, the joint can become chronically unstable and troublesome. A sprain is diagnosed as chronic if it lasts for more than four weeks. This is because by then the muscles have become weak and the ligaments lax. This predisposes the joint to instability and repeated injury.

The best way to prevent ankle sprains is to maintain good strength, muscle balance and flexibility.

• Don’t start exercising with “cold” stiff muscles. Warm ups are essential to prevent dislocations.

• Run in well-lit areas. That way, uneven surfaces, stones and obstructions can be seen well.

• Pay attention to footwear. Wear sports shoes for games. Formal stilettos, spiky heels and elevated shoes can cause loss of balance and are better avoided.

• If the ankle suddenly pains, stop the activity and check to see what is wrong.

To learn more You may click to-> ……………………….(1)....(2).….(3)……(4)

Sources: The Telegraph (Kolkata, India)

Dystonia

Definition:
Dystonia is the term used to describe a condition that causes involuntary sustained muscle contractions that lead to abnormal movements and postures.

It is a neurological disorder but does not lead to problems with other functions of the brain such as intellect.It is a neurological movement disorder in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. The disorder may be inherited or caused by other factors such as birth-related or other physical trauma, infection, poisoning (eg. lead poisoning) or reaction to drugs.

CLICK TO SEE THE PICTURE

 

Types of Dystonia:

* Generalized
* Segmental
* Intermediate

The Focal Dystonias:

These are the most common dystonias and tend to be classified as follows:

* Cervical dystonia (spasmodic torticollis). This affects the muscles of the neck, causing the head to rotate to one side, to pull down towards the chest, or back, or a combination of these postures.

* Blepharospasm. This affects the muscles around the eyes. The sufferer experiences rapid blinking of the eyes or even their forced closure causing effective blindness.

* Oculogyric crisis. An extreme and sustained (usually) upward deviation of the eyes often with convergence causing diplopia. It is frequently associated with backwards and lateral flexion of the neck and either widely opened mouth or jaw clenching. Frequently a result of antiemetics such as the neuroleptics (e.g. prochlorperazine) or metoclopramide.

* Oromandibular dystonia. This affects the muscles of the jaw and tongue, causing distortions of the mouth and tongue.

* Spasmodic dysphonia/Laryngeal dystonia. This affects the muscles of the larynx, causing the voice to sound broken or reducing it to a whisper.

* Oromandibular dystonia: Dystonia affecting the muscles of the jaw, tongue and mouth

* Laryngeal dystonia: Dystonia affecting the speech muscles

* Writer’s cramp: Dystonia affecting the ability to write and sometimes other hand-based tasks

There are other types of dystonia that affect more than one area, including generalised dystonia that affects most of the body, frequently involving the legs and back (trunk).

Focal hand dystonia (also known as musician’s or writer’s cramp). This affects a single muscle or small group of muscles in the hand. It interferes with activities such as writing or playing a musical instrument by causing involuntary muscular contractions. The condition is “task-specific,” meaning that it is generally only apparent during certain activities. Focal hand dystonia is neurological in origin, and is not due to fatigue.

The combination of blepharospasmodic contractions and oromandibular dystonia is called cranial dystonia or Meige’s syndrome.

Segmental Dystonias:

Segmental dystonias affect two adjoining parts of the body:

* Hemidystonia. This affects an arm and a leg on one side of the body.

* Multifocal dystonia. This affects many different parts of the body.

* Generalized dystonia. This affects most of the body, frequently involving the legs and back.

Causes:
The cause(s) of dystonia are not yet known or understood; however, they are categorized as follows on a theoretical basis:

Primary dystonia is suspected to be caused by a pathology of the central nervous system, likely originating in those parts of the brain concerned with motor function, such as the basal ganglia, and the GABA (gamma-aminobutyric acid) producing Purkinje neurons. The precise cause of primary dystonia is unknown. In many cases it may involve some genetic predisposition towards the disorder combined with environmental conditions.

Secondary dystonia refers to dystonia brought on by some identified cause, usually involving brain damage, or by some unidentified cause such as chemical imbalance. Some cases of (particularly focal) dystonia are brought on after trauma, are induced by certain drugs (tardive dystonia), or may be the result of diseases of the nervous system such as Wilson’s disease.

It has been suggested that an imbalance of neurotransmitters (such as dopamine) leads to this defect in control of muscles and movement.

In some cases, damage to the basal ganglia can lead to dystonia.

These are referred to as secondary dystonia and can be due to a variety of causes such as stroke or tumour of the basal ganglia, or the result of certain drugs (especially dopamine blocking drugs used to treat psychiatric disorders) and so on.

In the majority of cases, no underlying cause is found apart from possible genetic factors, and these are called primary or idiopathic dystonia.

Who is affected by dystonia?
Dystonia affects men and women of all ages.

If it develops in childhood, it tends to become generalised.

Dystonia which has its onset in adult life usually remains focal and is more common in those over 40 years of age.

The condition can be difficult to diagnose and many patients remain untreated because their symptoms are unrecognised.

Is it inherited?

Dystonia that develops in childhood is often inherited through one or more affected genes.

Most primary segmental or generalised dystonia is inherited in a dominant manner, which means that if a parent has this type of dystonia, there is a 50% chance of passing the dystonia gene to each child.

However, not everyone who inherits the gene develops dystonia, a phenomenon known as reduced penetrance.

Dystonia which develops in adults may also be inherited.

This is often difficult to identify, since other family members may have only a mild form of the illness. They may have never sought medical advice or perhaps their dystonia was misdiagnosed.

Symptoms:
Symptoms vary according to the kind of dystonia involved. In most cases, dystonia tends to lead to abnormal posturing, particularly on movement. Many sufferers have continuous pain, cramping and relentless muscle spasms due to involuntary muscle movements.

Click & see the pictures

Early symptoms may include loss of precision muscle coordination (sometimes first manifested in declining penmanship, frequent small injuries to the hands, dropped items and a noticeable increase in dropped or chipped dishes), cramping pain with sustained use and trembling. Significant muscle pain and cramping may result from very minor exertions like holding a book and turning pages. It may become difficult to find a comfortable position for arms and legs with even the minor exertions associated with holding arms crossed causing significant pain similar to restless leg syndrome. Affected persons may notice trembling in the diaphragm while breathing, or the need to place hands in pockets, under legs while sitting or under pillows while sleeping to keep them still and to reduce pain. Trembling in the jaw may be felt and heard while lying down, and the constant movement to avoid pain may result in TMJ-like symptoms and the grinding and wearing down of teeth. The voice may crack frequently or become harsh, triggering frequent throat clearing. Swallowing can become difficult and accompanied by painful cramping.

Electrical sensors (EMG) inserted into affected muscle groups, while painful, can provide a definitive diagnosis by showing pulsating nerve signals being transmitted to the muscles even when they are at rest. The brain appears to signal portions of fibers within the affected muscle groups at a firing speed of about 10 Hz causing them to pulsate, tremble and contort. When called upon to perform an intentional activity, the muscles fatigue very quickly and some portions of the muscle groups do not respond (causing weakness) while other portions over-respond or become rigid (causing micro-tears under load). The symptoms worsen significantly with use, especially in the case of focal dystonia, and a “mirror effect” is often observed in other body parts: use of the right hand may cause pain and cramping in that hand as well as in the other hand and legs that were not being used. Stress, anxiety, lack of sleep, sustained use and cold temperatures can worsen symptoms.

Direct symptoms may be accompanied by secondary effects of the continuous muscle and brain activity, including disturbed sleep patterns, exhaustion, mood swings, mental stress, difficulty concentrating, blurred vision, digestive problems and short temper. People with dystonia may also become depressed and find great difficulty adapting their activities and livelihood to a progressing disability. Side effects from treatment and medications can also present challenges in normal activities.

In some cases, symptoms may progress and then plateau for years, or stop progressing entirely. The progression may be delayed by treatment or adaptive lifestyle changes, while forced continued use may make symptoms progress more rapidly. In others, the symptoms may progress to total disability, making some of the more risky forms of treatment worth considering.

An accurate diagnosis may be difficult because of the way the disorder manifests itself. Sufferers may be diagnosed as having similar and perhaps related disorders including Parkinson’s disease, essential tremor (ET), carpal tunnel syndrome, TMJ, Tourette’s syndrome, or other neuromuscular movement disorders.

Treatment:
Treatment has been limited to minimizing the symptoms of the disorder as there is yet no successful treatment for its cause. Reducing the types of movements that trigger or worsen dystonic symptoms provides some relief, as does reducing stress, getting plenty of rest, moderate exercise, and relaxation techniques. Various treatments focus on sedating brain functions or blocking nerve communications with the muscles via drugs, neuro-suppression or denervation. All current treatments have negative side effects and risks.

Physicians may prescribe a series of different medications on a trial basis in an effort to find a combination that is effective for a specific patient. Not all patients will respond well to the same medications. Drugs that have had positive results in some patients include anti-Parkinsons agents (Trihexyphenidyl), muscle relaxers (Valium), keppra, and beta-blockers including “off-label” uses for some blood pressure medications.

Drugs such as anticholinergics, which act as inhibitors of the neurotransmitter acetylcholine, may provide some relief. Clonazepam, an anti-seizure medicine, is also sometimes prescribed. However, for most sufferers their effects are limited and side effects like mental confusion, sedation, mood swings and short-term memory loss occur.

Botulinum toxin injections into affected muscles have proved quite successful in providing some relief for around 3-6 months, depending on the kind of dystonia. Botox injections have the advantage of ready availability (the same form is used for cosmetic surgery) and the effects are not permanent. There is a risk of temporary paralysis of the muscles being injected or the leaking of the toxin into adjacent muscle groups causing weakness or paralysis in them. The injections have to be repeated as the effects wear off and around 15% of recipients will develop immunity to the toxin. There is a Type A and Type B toxin approved for treatment of dystonia; often those that develop resistance to Type A may be able to use Type B.

Surgery, such as the denervation of selected muscles, may also provide some relief; however, the destruction of nerves in the limbs or brain is not reversible and should only be considered in the most extreme cases. Recently, the procedure of deep brain stimulation (DBS) has proved successful in a number of cases of severe generalised dystonia.

One type of dystonia, dopa-responsive dystonia, can be completely treated with regular doses of L-dopa in a form such as Sinemet (carbidopa/levodopa). Although this doesn’t remove the condition, it does alleviate the symptoms most of the time.

A baclofen pump has been used to treat patients of all ages exhibiting muscle spasticity along with dystonia. The pump delivers baclofen via a catheter to the thecal space surrounding the spinal cord. The pump itself is placed in the abdomen. It can be refilled periodically by access through the skin.

Physical therapy can sometimes help with focal dystonia. A structured set of exercises is tailored to help the affected area.

Prognosis:Unfortunately, there is not yet a cure for most forms of dystonia. Nowadays, however, many dystonic conditions can be very successfully managed. In many cases, if dystonia develops in childhood, particularly if it starts in the legs, it may spread to other parts of the body and can become generalised.

However, when it develops in adults, it usually confines itself to one part of the body (focal dystonia). The progress of dystonia is unpredictable.
The severity of symptoms can vary from day to day, and while there often is an element of overall progression, it is difficult to estimate how long this will last.Typically, a focal dystonia will progress very gradually over a five-year period, and then progress no further. Symptoms in all dystonic conditions can vary.
For some people, their dystonia may sometimes improve or disappear altogether for no apparent reason.


Living with Dystonia:

As with the onset of any long-term medical condition, some people who develop dystonia may go through an initial period of depression, embarrassment and outrage – or relief that there is an explanation for their symptoms.

Most people do manage to develop effective strategies for coping with the challenges that their condition brings.

Successful treatments to lessen their symptoms, effective pain control and the acquisition of sensory ‘tricks’ all help to ameliorate social situations.

Development:In the last few years, awareness of dystonia has increased and the outlook for people with dystonia is improving.

The Dystonia Society, a registered charity, works hard to speed up the processes of both research and recognition.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://en.wikipedia.org/wiki/Dystonia
http://news.bbc.co.uk/2/hi/health/medical_notes/6237440.stm