Dystonia

Dystonia Treatment in Hyderabad

Dystonia is defined as a movement disorder that causes involuntary muscle contractions. In this condition, muscles contract uncontrollably, resulting in repeated or twisting movements. 

The disorder can affect one area of your body called focal dystonia, two or more neighbouring sections called segmental dystonia, or your entire body called global dystonia & general dystonia. 

Muscle spasms can be moderate to severe. They can be painful and can make it difficult to conduct day-to-day chores. Dystonia has no known cure. Medications, on the other hand, can help to alleviate symptoms. If one has severe dystonia, they may need Dystonia Treatment in Hyderabad to block or regulate nerves or specific brain regions. The procedure is conducted at CARE Hospitals where medical professionals perform surgery using top-notch technology. 

Symptoms

Dystonia can affect people in many ways. Some of the symptoms include:

• They begin by affecting a specific part of your body. It can be the leg, neck, or arm. After the age of 21, focal dystonia can occur in the neck, arm, or face. It tends to stay focal or segmental.

• It can happen when one is doing special focused tasks like handwriting.

• Stress, weariness, or anxiety exacerbate the problem.

• With time, they can get worse.

Areas of the body that can get affected-

• Back of the neck or cervical dystonia: Contractions cause your head to twist and move to a side, and pull forward or backwards. It can be painful.

• Eyelids: Your eyes close (blepharospasms) due to rapid blinking or involuntary spasms, making it difficult to see. Spasms are normally not unpleasant. These tend to increase when you're in bright light, stressed, or engaging with others. The eyes can also go dry.

• The jaw or the tongue or the oromandibular dystonia- Slurred speech, drooling, and difficulty in eating & swallowing are symptoms related to the tongue. Oromandibular dystonia is a painful condition that usually arises with cervical dystonia (abnormal contractions of neck muscles) or blepharospasms (abnormal contraction of eyelid msucles).

• The vocal cords and the voice box or spasmodic dystonia- It affects voice or speech. You may experience a hushed or whispered tone in your voice.

• Forearm and hand- Some dystonia also happen when one is doing something repetitive. It can be writing (writer's dystonia) or playing a musical instrument (musician's dystonia).

Causes

Most cases of dystonia lack a clear, identifiable cause. It appears to be linked to a dysfunction in the basal ganglia, the region of the brain responsible for regulating muscle contractions. This dysfunction affects how nerve cells communicate, leading to abnormal muscle movements.

Dystonia is classified into three main categories:

• Genetic Dystonia: This form is inherited and caused by genetic mutations affecting the brain's control over muscle movements.
• Acquired Dystonia: Also known as secondary dystonia, it results from brain damage or injury due to factors like stroke, trauma, infections, or exposure to certain medications.
• Idiopathic Dystonia: In this type, the cause remains unknown, and there is no evidence of genetic or acquired factors.

Dystonia Types

Dystonia is a complex neurological condition, and specialists often use two axes to classify it, providing a comprehensive understanding of the disorder.

• Axis 1: Clinical Presentation: This axis focuses on how dystonia manifests in patients, including the patterns of muscle contractions and the areas of the body affected. It includes:
  • Focal Dystonia: Involves a specific muscle group or region, such as cervical dystonia (neck muscles) or blepharospasm (eyelid muscles).
  • Segmental Dystonia: Affects two or more adjacent body parts, like the neck and shoulder.
  • Generalized Dystonia: Involves multiple areas of the body, often leading to more severe disability.
  • Task-Specific Dystonia: Occurs during particular activities, such as writing or playing an instrument.
  • Myoclonic Dystonia: Combines features of dystonia with sudden, involuntary muscle jerks.
• Axis 2: Etiological Classification: This axis categorizes dystonia based on its underlying causes, distinguishing between primary and secondary forms:
  • Primary Dystonia: Usually genetic, with no identifiable external cause. It is often hereditary and linked to specific genetic mutations.
  • Secondary Dystonia: Results from identifiable factors or conditions, such as:
    • Acquired Brain Injury: Trauma or damage to the basal ganglia from injuries, strokes, or infections.
    • Medications: Certain drugs can lead to tardive dystonia, characterized by involuntary muscle contractions as a side effect.
    • Toxins: Exposure to harmful substances like heavy metals or carbon monoxide can induce dystonic movements.

Risks/ Complications of dystonia

The risks or complications depend on the type of dystonia. The following are the common risks associated with the condition:

• Physical disabilities that cause ill effects on your performance in daily activities or specific tasks.

• Difficulty with vision that affects the eyelids.

• Difficulty with jaw movement, swallowing or language.

• Pain and fatigue by constant contraction of your muscles.

• Depression, anxiety and social withdrawal.

Diagnosis of dystonia

Diagnosis for dystonia includes physical examinations, evaluation of the medical history, and relevant investigations such as: 

• Blood and Urine Tests: These tests help to identify presence of toxins and other conditions.

• MRI and CT scan: They both are imaging tests and can determine brain abnormalities such as lesions, tumours, and stroke.

• Electromyography or the EMG: These tests can tell the electrical activity inside the muscles.

• Gene testing: Dystonia can have hereditary causes. These are determined by gene testing.

Treatment for dystonia

Doctors may treat dystonia using medications or surgery depending on the underlying cause: 

Therapy

The following therapies can be suggested by the doctor for the dystonia treatment:

• Physical therapy or occupational therapy- to help ease symptoms and improve nerve function.

• Speech therapy if your voice is affected.

• Stretching or massage to relax muscle pains.

Medicines

Injections of botulinum toxin (such as Botox or Dysport) into specific muscles can help reduce or stop muscle spasms. These injections typically need to be repeated every 3 to 4 months. Side effects are usually mild and temporary, including muscle weakness, dry mouth, or changes in voice.

Other medications target brain chemicals called neurotransmitters that influence muscle movement. These options include:

• Carbidopa-levodopa (Duopa, Rytary): This drug increases dopamine levels and may also be used to diagnose certain types of dystonia.
• Trihexyphenidyl and benztropine: These drugs affect neurotransmitters other than dopamine but may cause side effects like memory loss, blurred vision, drowsiness, dry mouth, and constipation.
• Tetrabenazine (Xenazine) and deutetrabenazine (Austedo): These medications block dopamine, with possible side effects such as sedation, nervousness, depression, or insomnia.
• Diazepam (Valium), clonazepam (Klonopin), and baclofen (Lioresal): These drugs reduce neurotransmission and may be helpful in certain forms of dystonia, though they can cause drowsiness.

Surgery 

Surgery happens when the symptoms are severe-

• Deep brain stimulation (DBS)- It is a type of brain stimulation. Electrodes are surgically placed in one specific area of your brain and linked to a generator in the chest. The generator provides electrical pulses to the brain. This may aid with muscular contraction control. The generator's settings can be adjusted according to you.

• Denervation surgery- It is done selectively. This surgery involves severing the nerves that govern muscle spasms. It may be an option for treating dystonia that hasn't responded well to conventional treatments. Your doctor will also prescribe any medications accordingly. 

Lifestyle and home remedies

Dystonia has no cure, but several strategies can help manage symptoms:

• Sensory tricks to alleviate spasms: Touching specific areas of your body might temporarily halt spasms.
• Heat or cold therapy: Using heat or cold therapy can help relieve muscle pain.
• Stress management: Developing effective coping skills, such as deep breathing, seeking social support, and practicing positive self-talk, can help manage stress.

Foods to avoid with dystonia

There is no evidence suggesting that diet impacts dystonia, so it's recommended to maintain a normal, balanced diet that meets your individual needs and symptoms. However, you may consider limiting or avoiding caffeine, as it is a stimulant that could potentially worsen your symptoms. Always consult your healthcare provider before making significant dietary changes.

Similarly, vitamins and supplements have not been shown to benefit dystonia. If you're considering trying one, it is crucial to discuss it with your provider first to ensure it is safe and will not interfere with any medications you are taking.

Prevention

Dystonia occurs unpredictably, making it impossible to prevent. You also can't lower the risk of developing primary dystonia since it’s either inherited or arises for unknown reasons.

However, certain causes of secondary dystonia can be prevented or minimized. Here’s what you can do:

• Maintain a balanced diet and healthy weight: Many conditions affecting circulatory and heart health, such as stroke, can damage brain areas linked to dystonia. Preventing or reducing these conditions may lower your risk.
• Address infections promptly: Quick treatment of eye and ear infections is crucial. If they spread to the brain, they can cause inflammation (encephalitis), potentially leading to dystonia.
• Use safety gear: Traumatic brain injuries can trigger dystonia, so wearing protective equipment is important to reduce your risk.
• Manage chronic health conditions: Conditions like Type 2 diabetes, high blood pressure, and epilepsy can contribute to dystonia. Proper management of these issues can reduce your risk.

Preparing for your appointment

You might be referred to a neurologist, a doctor who specializes in nervous system disorders.

• Gather Information: Note down your symptoms, their frequency, and any triggers or patterns you've noticed. Also, make a list of all medications, supplements, and treatments you are currently using.
• Medical History: Be prepared to discuss your medical history, including any previous diagnoses, surgeries, or relevant health issues.
• Family History: Know your family's medical history, particularly any instances of neurological disorders.
• Questions and Concerns: Write down any questions or concerns you have about your condition, treatment options, or prognosis.
• Support Person: Consider bringing a friend or family member to your appointment for support and help remember the information provided.
• Records: Bring any relevant medical records, test results, or imaging studies that might help your doctor better understand your condition.
• Lifestyle Factors: Be ready to discuss your daily routine, diet, exercise, stress levels, and any factors that might affect your symptoms.

Why Choose CARE Hospitals 

CARE Hospitals aim is to be India's most well-known healthcare provider, dedicated to the highest levels of clinical quality and patient care, backed by cutting-edge technology and research. We demand more of ourselves to provide the best dystonia treatment in Hyderabad. We strive for excellence in everything we do so that we can provide the best level of patient-centred care possible.