Treating Dystonia In Parkinsons
Treatment options for dystonia include:
- Dopaminergic medication adjustment as discussed above
- Botulinum toxin injections of the affected muscles
- Physical therapy to loosen and strengthen the dystonic body part
- Trying other medications that target the dystonia directly such as muscle relaxants or anti-cholinergic medications
- Use of a device to provide a sensory trick*.
- Deep brain stimulation can be considered in difficult-to-treat situations
*To minimize their dystonia, some people have success using an interesting tactic called a sensory trick. A sensory trick is defined as a physical gesture that mitigates the production of the dystonia. For example, touching the eyebrow may help keep the eyes open, or touching the chin may keep the neck from twisting. In my clinical practice, one woman wears metals rings on her dystonic fingers to help them assume a more normal position. Another man wears 5-toed shoes to prevent dystonic toe curling
What Are The Symptoms Of Dystonia
The symptoms of dystonia may vary from person to person. Various types of dystonia can affect only one muscle, groups of muscles or muscles throughout the body. In childhood or early-onset dystonia, the symptoms often start in the limbs and may progress to involve other parts of the body. Symptoms may occur after periods of exertion. They may fluctuate throughout the course of the day.
In adult-onset dystonia, the symptoms usually affect one or adjacent parts of the body, most often involving the neck and/or facial muscles.
Involuntary muscle contractions may affect a single area such as the leg, jaw or arm.
What Are The Different Forms Of Dystonia
There are many different forms of dystonia. Within Axis I, some are grouped by the regions of the body which they affect:
- Generalized dystonia affects most or all of the body.
- Focal dystonia is localized to a specific part of the body.
- Multifocal dystonia involves two or more unrelated body parts.
- Segmental dystonia affects two or more adjacent parts of the body.
- Hemidystonia involves the arm and leg on the same side of the body.
Some of the more common focal forms are:
Cervical dystonia, also called spasmodic torticollis or torticollis, is the most common of the focal dystonias. The muscles in the neck that control the position of the head are affected, causing the head to turn to one side or to be pulled forward or backward. Sometimes the shoulder is pulled up. Cervical dystonia can occur at any age, although most individuals first experience symptoms in midlife. It often begins slowly and usually reaches a plateau over a few months or years. About 10 percent of those with torticollis may experience a spontaneous remission, but unfortunately the remission may not be lasting.
Blepharospasm, the second most common focal dystonia, is the involuntary, forcible contraction of the muscles controlling eye blinks. The first symptoms may be increased blinking, and usually both eyes are affected. Spasms may cause the eyelids to close completely, causing functional blindness even though the eyes are healthy and vision is normal.
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Physical And Occupational Therapy
It may be difficult to exercise when you are in pain. However, if you are in pain while moving and suddenly stop, the pain can get worse. A physical or occupational therapist can recommend exercises or techniques to target the source of your pain and to stretch and strengthen the body parts most affected by dystonia.
Can You Work If You Have Dystonia
When dystonia is severe and prevents employment, it can qualify for Social Security Disability benefits. Although the Social Security Administration has no disability listing for dystonia, there are still several ways to qualify for benefits, including: Meeting a listing for another impairment you have.
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What Do We Know About The Connection Between Dystonia And Parkinsons
There is still a lot to learn about the connections between Parkinsons and dystonia but we know that both arise from problems in the circuit inside our brains responsible for controlling our movements, which is called the basal ganglia.
More recently, research has begun to reveal some of the potential genetic links between the two conditions.
Studies have shown that people with a rare inherited form of Parkinsons caused by changes in a gene called parkin not only tend to develop Parkinsons symptoms at a younger age but are also more likely to experience dystonia in their feet.
More recently, I was involved in a large genetic study which suggested that genetic mutations which cause a form of childhood-onset dystonia may also play a role in the development of Parkinsons.
Mutations in a gene called GCH1 result in a severe reduction of dopamine production and cause symptoms that appear in childhood, often about the age of six, including dystonia in the lower limbs. The symptoms respond very well to levodopa medication and as a result it is called dopa-responsive dystonia .
We studied the families of children with DRD and found older relatives who carry the same genetic defect who developed Parkinsons-like symptoms in adulthood. Crucially, when these individuals had a brain scan that we use to help diagnose Parkinsons , they looked like they had typical Parkinsons.
Dementia With Lewy Bodies
- Dementia with Lewy bodies is a progressive, neurodegenerative disorder in which abnormal deposits of a protein called alpha-synuclein build up in multiple areas of the brain.
- Dementia with Lewy bodies is second to Alzheimers as the most common cause of degenerative dementia that first causes progressive problems with memory and fluctuations in thinking, as well as hallucinations. These symptoms are joined later in the course of the disease by parkinsonism with slowness, stiffness and other symptoms similar to PD.
- While the same abnormal protein is found in the brains of those with PD, when individuals with PD develop memory and thinking problems it tends to occur later in the course of the disease.
- There are no specific treatments for DLB. Treatment focuses on symptoms.
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Dyskinesia Vs Dystonia: Understanding The Difference
- Dyskinesia and dystonia are common conditions that develop in people with Parkinsons disease and other movement disorders.
- Dyskinesia is a side effect of the medication used to treat Parkinsons. Dystonia can be caused by medication, or it may be a symptom of the disease itself.
- Dyskinesia and dystonia can be treated similarly through deep brain stimulation or modifications to medication.
Parkinsons medications like levodopa can cause motor symptoms known as dyskinesia. Another set of motor symptoms, dystonia, can also develop as a side effect of Parkinsons medications, or as a direct symptom of Parkinsons or another movement disorder.
Parkinsons disease is a neurological disorder characterized by a lack of the neurotransmitter dopamine in the brain. This chemical messenger is responsible for controlling muscle movements. When dopamine levels are low, signaling is disrupted, leading to the development of movement disorders. Parkinsons is treated with dopaminergic treatments to increase dopamine levels or mimic the chemical to improve symptoms.
Parkinsons disease and other forms of parkinsonism are characterized by abnormal movements, bradykinesia , and myoclonus .
Exercise Stretch And Strengthen
- Even if you dont feel like it, exercising every day can increase flexibility in your muscles and joints, reduce pain and discomfort, and improve circulation. Exercise can increase the secretion of your happy hormones, improve your mood, and decrease anxiety and depression.
- If you have discomfort in your calves, ankles, feet, or toes, and try the eight exercises physical therapist Sarah King recommends.
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Is Dystonia A Form Of Parkinson’s
Dystonia can be one of the symptoms of Parkinsons disease . PD is a long-term neurological movement disorder with various symptoms ranging from slowness of movement , rigidity of muscles, tremor, loss of balance, memory impairment, personality changes and others. In young-onset PD, foot dystonia may be the first feature. Later, other symptoms such as personality changes and memory impairment become noticeable.
Dystonia may sometimes develop as an isolated symptom in individuals who do not have PD. It may be seen in people who suffer from Huntingtons chorea, birth injury, stroke, brain infections, etc. Sometimes, a person with Parkinsons may develop dystonia due to the drug Leva Dopa that is given as a part of PD treatment.
Dystonia is a neurological disorder that purely affects movement and is characterized by involuntary contractions of the muscles causing repetitive or twisting movements or abnormal postures. Dystonia can occur in isolation or as a symptom of PD. It, however, does not affect everyone with PD.
Both PD and dystonia seem to occur due to the involvement of a part of the brain called the basal ganglia. Thus, the symptoms of both can occur in the same person.
Where Can I Get More Information
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network at:
Office of Communications and Public LiaisonNational Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesda, MD 20892
NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.
All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.
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How Is Dystonia Classified
Dystonia is classified along two distinct axes.
- Axis I is based on clinical features which include age at onset, body region affected, specific features, and whether there are associated clinical problems.
- Axis II is based on etiology or cause. This classification includes dystonia caused by genetics or abnormalities in the brain, and idiopathic dystonia, for which the cause is unknown.
Treatments Options For Dystonia
Since often times, Parkinsons and dystonia go hand in hand, so do many of the different forms of treatments. Medication such as anticholinergic drugs – they basically block the brain from messaging the muscles – can improve the tremors, muscle contractions, and weaknesses, all the things that pop up with both conditions. Unfortunately, over time, some of the medications lose their potency and the relief that some patients may experience at the beginning may wear off.
Other times, medications like muscle relaxants can help, as can botulinum toxin injections. In everyday language, those are Botox injections. In this case, they are not being used as a beauty tool – rather they are being used to temporarily paralyze the muscle and prevent contractions.
A much more invasive form of treatment – and one that is sometimes used by those with Parkinson – is deep brain stimulation. This is when brain surgery is done and doctors re-wire the part of the brain that is causing issues.
Finally, some patients find relief from a combination of treatments paired with different forms of physical therapy including yoga, tai-chi, meditation, and specialized exercises. At the moment, there is no known research to back-up the theory that this may be beneficial to dystonia patients. Anecdotally, the results are glowing and all forms of physical therapies receive great reviews.
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When Do Symptoms Occur
Dystonia can occur at any age, but genetic and idiopathic dystonia are often divided as either early, or childhood onset, versus adult onset.
- Early onset dystonia often begins with symptoms in the limbs and may progress to involve other regions. Some symptoms tend to occur after periods of exertion and/or fluctuate over the course of the day.
- Adult onset dystonia usually is located in one or adjacent parts of the body, most often involving the neck and/or facial muscles. Acquired dystonia can affect other regions of the body.
Dystonia often progresses through various stages. Initially, dystonic movements may be intermittent and appear only during voluntary movements or stress. Later, individuals may show dystonic postures and movements while walking and ultimately even while they are relaxed. Dystonia can be associated with fixed postures and shortening of tendons.
Whats The Outlook For People With Dystonia
If dystonia begins in childhood, it is more likely that symptoms will spread to other body areas. If dystonia begins in adulthood, it usually affects one area. If it does spread, it usually spreads to an adjacent area.
Dystonia symptoms and their severity can vary day to day and from person to person.
Botulinum toxin injections, medications and surgery have all been shown to be effective in treating dystonia. Choice of treatment option depends on type of dystonia, underlying cause, muscles involved and severity of symptoms. Deep brain stimulation is generally considered only after injections and medications have failed to provide adequate relief and symptoms continue to interfere with quality of life.
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Can Cbd Oil Help Dystonia
Although the studies are scarce, CBD seems to be effective on treating dystonic movements, both primary and secondary. It is noteworthy that in some cases, particularly concerning multiple sclerosis and HD, the clinical beneficial effects are observed only when CBD is combined with 9-THC in a 1:1 ratio .
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What Are The Symptoms
Dystonia can affect many different parts of the body and the symptoms are different depending upon the form of dystonia. Symptoms may include:
- a foot cramp or a tendency for one foot to turn or drageither sporadically or after running or walking some distance
- a worsening in handwriting after writing several lines
- the neck may turn or pull involuntarily, especially when the person is tired or under stress
- both eyes might blink rapidly and uncontrollably other times, spasms will cause the eyes to close
- tremor
- difficulty speaking
The initial symptoms can be very mild and may be noticeable only after prolonged exertion, stress, or fatigue. Over time, the symptoms may become more noticeable or widespread sometimes, however, there is little or no progression.
In some cases, dystonia can affect only one specific action, while allowing others to occur unimpeded. For example, a musician may have dystonia when using a hand to play an instrument, but not when using the same hand to type.
Dystonia may cause pain due to muscle contractions but typically is not associated with problems thinking or understanding. Depression and anxiety may occur.
S Of The Body Affected By Dystonia
- Arms, hands, legs and feet: Involuntary movements, spasms or twisting and “curling”
- Neck: May twist uncomfortably, causing the head to be pulled down or to the side. This is called cervical dystonia or spasmodic torticollis
- Muscles around the eyes: May squeeze involuntarily, leading to a person to blink too much or to have difficulty opening the eyes. This is also called blepharospasm
- Vocal cords and swallowing muscles: May cause a person’s voice to sound softened, hoarse or breathy
- Jaw: May open or close forcefully or there may be grimacing of the face
- Abdominal wall: May cause sustained contractions and involuntary, writhing movements of the abdominal wall or close forcefully, or there may be grimacing of the face.
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What Does Dystonia Feel Like
For some people, dystonia feels like a Charlie horse, which can be so painful that it wakes you up at night. For some, it feels like opposing muscles, muscles that work in pairs, are competing with each other. For example, when your bicep muscle contracts, your tricep muscle relaxes or elongates. In dystonia, both muscles want to contract at the same time, and it feels like theyre fighting. For some people living with Parkinsons, dystonia is the most distressing symptom they experience.
Some Experts Estimate That Forty Percent Of People Living With Parkinsons Disease Experience Dystonia As An Early Symptom Or As A Complication Of Treatment
What is the relationship between Parkinsons and dystonia?
Dystonia and Parkinsons disease are movement disorders that are closely related. Parkinsonism is a term used to describe any clinical presentation that manifests in the cardinal symptoms of Parkinsons disease .
Main Types of Dystonia
There are two main categories of dystonia: primary and secondary . Primary dystonia is a condition in which dystonia is the only clinical feature. There is no evidence of cell death or a known cause. It is also known as idiopathic torsion dystonia. Primary dystonia is thought to have greater genetic contribution, even in the absence of a family history of dystonia. Among forms of primary dystonia, the most common is generalised dystonia, which affects the legs or one leg and the trunk, plus other regions, most commonly the arms.
Outside the context of Parkinsons disease, there are several other types of secondary dystonia, in which other symptoms are also present. In this category are:
- Myoclonus dystonia, characterised by dystonia and myoclonus , with onset in childhood or adolescence.
- Dopa-responsive dystonia, a genetic disorder of childhood-onset and may have features of parkinsonism or exaggerated reflex responses.
- Rapid-onset dystonia parkinsonism, a rare inherited disorder characterised by sudden development of dystonia and parkinsonism.
- Paroxysmal dystonia, neurological conditions characterised by discrete and sudden episodes of involuntary movements.
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Is Dystonia A Form Of Parkinsons
Dystonia can be a symptom of Parkinson’s disease.
Dystonia can be one of the symptoms of Parkinsons disease . PD is a long-term neurological movement disorder with various symptoms ranging from slowness of movement , rigidity of muscles, tremor, loss of balance, memory impairment, personality changes and others. In young-onset PD, foot dystonia may be the first feature. Later, other symptoms such as personality changes and memory impairment become noticeable.
Dystonia may sometimes develop as an isolated symptom in individuals who do not have PD. It may be seen in people who suffer from Huntingtons chorea, birth injury, stroke, brain infections, etc. Sometimes, a person with Parkinsons may develop dystonia due to the drug Leva Dopa that is given as a part of PD treatment.
Dystonia is a neurological disorder that purely affects movement and is characterized by involuntary contractions of the muscles causing repetitive or twisting movements or abnormal postures. Dystonia can occur in isolation or as a symptom of PD. It, however, does not affect everyone with PD.
Both PD and dystonia seem to occur due to the involvement of a part of the brain called the basal ganglia. Thus, the symptoms of both can occur in the same person.