Dystonia, a movement disorder disease, causes involuntary movements of the muscles. Dystonia, the most common type of movement disorder after Parkinson’s and essential tremor, is characterized by slow repetitive movements or abnormal posture. Dystonia, which causes involuntary contractions and twisting (causing twisting) movements, leads to unexpected body movements such as jerking or shaking. Dystonia, which can affect any part of the body, can often cause pain as a result of involuntary muscle movements such as the eyes, neck, legs, arms, and hands. Dystonia, which is a neurological syndrome, is examined under the title of hyperkinetic movement disorders. The disease differs from other movement disorders in that the contractions are long-lasting, strong, and consistently in the same muscle group. Although the neurochemical changes that play a role in the formation of dystonia are not yet fully understood, dystonia is thought to occur due to an anomaly or damage to the brain or basal nuclei that control muscles and movements. Before proceeding with the diagnosis and treatment methods of It, which is examined in two separate groups as primary and secondary dystonia.
What is Dystonia?
Although it is the most common movement disorder disease after it, Parkinson’s, and essential tremor diseases, it is not well known by the public. The disease, which is mostly seen in adults, can be seen in adolescents and children in some cases. that begins in adulthood usually affects only one part of the body, whereas childhood dystonia often affects more than one part of the body. İt, which is characterized by involuntary contractions and twitches that occur in all or a part of the body, can cause distortion of body posture by causing bending from time to time. In other words, the contraction, bending, and twisting movements that occur in the presence of dystonia may cause abnormal posture or tremor (tremor) affecting the arms, legs, trunk, head, face, vocal cords. For example, involuntary contractions in the neck muscles can cause the person to tilt their head involuntarily. Due to the contractions in the facial muscles, the person may involuntarily make different facial expressions or blinking movements. Speech disorders may occur if the jaw is affected. Dystonia is examined in two different groups in terms of its causes:
- Primary Dystonias: Primary type of unknown cause, most often seen in young people between the ages of 20 and 30. Although stress does not cause primary dystonia, the presence of stress in patients with dystonia may increase the symptoms and complaints of the patient. the most common form of dystonia is the most common movement disorder after the essential tremor, tic, and Parkinson’s disease. There have been many developments regarding it over the past 20 years. With the human genome project led by HUGO (human genome organization), genetic discoveries, and the discovery of additional variants, research has accelerated. In the light of this information, primary dystonias are currently evaluated in twenty subtypes ranging from DYT1 to DYT20.
- Secondary Dystonia: that occurs after birth mostly occurs due to external factors such as drug side effects and exposure to different toxins. Brain injuries, autoimmune or infectious infections, mitochondrial diseases, It can be caused. Neurodegenerative diseases such as Wilson’s disease and tic disorders can also be considered within the scope of it. Although that includes many different disease groups, the diagnosis can be made easily when accompanying diseases such as the age of onset of the disease, personal history, family history, growth retardation, ataxia, psychosis, spasticity, and hearing loss are taken into consideration. The presence of factors such as occupational diseases, occupational accidents, or exposure to trauma facilitates the diagnosis of dystonia since it does not require additional examination.
What are the Classes of Dystonia?
Dystonia, which can occur at any age, can be seen in childhood or adulthood. Early-onset dystonia usually begins in a single part of the body such as the arm or leg and may spread to other areas over time. Some symptoms may appear or increase during exercise, when stress levels increase, or at a certain time of the day. Although It in adults mostly affects the muscles of the neck and face, symptoms can also be seen in other parts of the body. Although adult it can be progressive, it often does not progress. Another way of classifying it is the area of the body affected by it:
- Generalized Dystonia: The whole body is affected by the disease.
- Focal Dystonia: In this local dystonia class, a certain part of the body is affected by the disease.
- Multifocal Dystonia: It is a class of dystonia in which two or more independent body parts of the body are affected.
- Segmental Dystonia: Two adjacent parts of the body are affected by the disease.
- Hemidystonia: It is the dystonia class in which one side of the body or in other words the arm and leg on the same side of the body are affected.
What are the Subtypes of Dystonia?
There are many subtypes of dystonias. The main ones can be listed as follows:
- Cervical Dystonia: İt, also known as torticollis or spasmodic torticollis in medicine, is the most common type of focal dystonia. In the presence of It, the necks of the patients are most affected and the posture position of the head is disrupted accordingly. The head is tilted right, left, forward, or backward. In some cases, the shoulder may accompany the head and disrupt the person’s posture. That, which can occur at almost any age, usually begins in middle age. The discomfort, which initially progresses with mild symptoms, progresses within a few months or years.
- Blepharospasm: The second most common type of It, blepharospasm is caused by involuntary contraction of the muscles that cause blinking. The first symptom seen in the presence of blepharospasm is the increased frequency of blinking. It is mostly seen in both eyes and the resulting spasm may cause the eye to close completely over time. Although there is no impairment in the eyesight, functional blindness may occur.
- Craniofacial Dystonia: In this subtype of It, the muscles of the face, head, and neck are affected.
- Oromandibular Dystonia: In this subtype in which the lips, jaw, and tongue muscles are affected, daily activities such as talking, eating, or mouth movements become difficult. It can spread to other body parts within 5 to 10 years after the disease begins. Teeth grinding (bruxism) is common in people with jaw dystonia.
- Spasmodic Dystonia: That, also defined as laryngeal dystonia in medicine, occurs when the vocal cords, or commonly known as the vocal cords, are affected by the control muscle groups. Symptoms such as cracking, hoarseness, and thinning occur that reduce the quality of the sound. Laryngeal dystonia, which is more common in women, can cause the person to be out of breath or to speak in a whisper. However, other functions such as laughing and singing are not affected.
- Printer’s Cramp and Other Task Dystonias: The most common clinic in task dystonia, which is thought to be predisposed to constantly repetitive fine motor movements, is printer cramp. Involuntary contractions can occur when writing or just holding a pencil. There are also cases in which ankle and even shoulder involvement is observed. If dystonic movement occurs only while writing, it is defined as a simple printer cramp. However, if this situation is observed in other hand movements, the discomfort is called It writer’s cramp. The disease is common in secretarial, painting, bakers, pianists, darts, and golf players.
Dystonia Diagnosis and Treatment Methods
Although it is not yet fully understood what causes dystonia, studies on this subject continue. When the patient applies to the physician for the diagnosis of dystonia, which often occurs spontaneously, the physician listens to the patient’s history. It questions when the complaints have existed, how old the disease started, where the affected body area is, whether the discomfort started suddenly and whether it got worse over time. It investigates the presence of different clinical problems. Then he performs a neurological examination. In some cases, additional laboratory and radiological imaging tests are required. Mild or initial dystonia may not be diagnosed. However, if the symptoms are severe, a diagnosis is made. In the presence of foci leading to it, the focal disease is treated. Apart from these, some drug groups can be used to help the patient relax. In case of insufficient response to medical treatment, a peripheral or central surgical treatment method is preferred.
If you think you have one of the subtypes of dystonia, do not neglect to apply to the nearest healthcare facility and have your controls.
We wish you healthy days.
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