Dystonia is a hyperkinetic movement disorder that can be both painful and debilitating. It is the third most common movement disorder and can also be a symptom of other diseases. The University of Michigan Health System Movement Disorders Program offers sophisticated treatments for dystonia, with care delivered by experienced neurologists who are specially trained in movement disorders and treat only these conditions. Our neurologists work closely with neurosurgeons, neuropsychologists, speech therapists and physical rehabilitation specialists to offer a multidisciplinary approach to care. U-M is also home to one of the largest dystonia research centers in the country, where we are trying to better understand the genetics of the disease, how it works and better ways to treat it.
Dystonia is characterized by abnormal sustained co-contractions of opposing muscle groups that cause twisting or repetitive movements and abnormal postures. There are different categories of dystonia, depending on the number of muscle groups affected.
Categories of Dystonia
- Focal. Affects localized muscles in one area such as the face, neck, larynx/vocal cords, or limbs. Examples include blepharospasms, or involuntary contractions of the eyelid muscles, and cervical dystonia, marked by muscle spasms of the head and neck which causes the neck to twist into unusual positions. This category also includes task-specific dystonia such as musician’s or writer’s cramp.
- Regional. Affects larger areas of the body, such as the shoulders or neck.
- General. Affects most of the body and frequently involves the back and legs.
Dystonia can be primary, meaning a patient’s MRI is normal and there is no known cause, or secondary, meaning the cause is known. People usually seek treatment when dystonia interferes with the quality and functioning of day-to-day life. Because dystonia can also be indicative of other conditions, our neurologists thoroughly evaluate each patient and run all necessary tests to determine why they are experiencing symptoms.
For many patients with dystonia, medications or Botox treatments may adequately treat their condition. Botox works by relaxing the muscles, and is particularly effective in patients with focal dystonia. It is a low-risk treatment and patients typically receive injections every few months.
For patients with primary regional or general dystonia, deep brain stimulation (DBS) can significantly improve symptoms and pain levels, thus improving quality of life. These benefits can be long-lasting and increase over time. DBS involves placing electrodes in precise locations of the brain. The electrodes are connected to a wire that runs underneath the skin to a battery in the chest. When electrical stimulation is delivered to the brain, symptoms improve. It’s like a pacemaker for the brain, instead of the heart. DBS is reversible and is programmed to each patient’s individual needs.
For those with severe general dystonia who haven’t had success with other treatments, an ITB (intrathecal baclofen) Pump can be effective in helping to control symptoms. Baclofen is a drug used to manage severe spasticity. An ITB Pump is placed under the skin at the belly, which delivers programmable dosages of the medication via a catheter placed in the spinal canal. The surgery is low-risk. Patients who have secondary dystonia respond better to this treatment than those with primary dystonia.