Good Practice Guide


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Type of Dystonia

Muscles affected

Symptoms

Symptoms commonly misdiagnosed as:

Indicators for a GP that diagnosis may be dystonia

Primary generalised dystonia

Throughout the body, particularly the trunk and limbs

• Turning in or dragging of foot or leg
• Clumsy or unsteady walking
• Painful twisting posture

• Orthopaedic problem
• Psychological problem

• Movement worse at certain times of day or when stressed and tired
• Movements often not present when sleeping
• Does not respond well to splinting or other corrective therapeutic techniques
• Movement still present when patient unaware of being observed

Dopa-responsive dystonia  Throughout the body, particularly the trunk and legs • Turning in or dragging of foot or leg
• Clumsy or unsteady walking / affects mobility
• Painful twisting postures
• Symptoms worsen as day progresses
• Orthopaedic problem
• Psychological problem
• Movement better in the morning and worse at end of the day or when stressed and tired
• Movements often not present when sleeping
• Other family members affected
• Movement still present when patient unaware of being observed
Cervical dystonia Neck • Causes head to twist
• Often associated with tremor
• Can be extremely painful
• Neck damage
• Pulled muscle / Muscle strain
• Slept the wrong way
• Head trauma
• Psychological problem
• Does not respond to physiotherapy or pain killers
• Does not clear up over time
• Symptoms sometimes ease with sensory tricks  (such as putting a finger on the chin)
• Movement still present when patient unaware of being observed
Blepharospasm Around the Eyes • Excessive blinking
• In more severe cases, eyes can spontaneously clamp shut
•  Usually presents in both eyes
• Dry eye
• Eye strain / tired eyes  / tic (e.g. from overuse of computer or reading)
• Myasthenia Gravis
• Psychological problem
• Does not respond to dry eye treatment
• Does not clear up over time
• Dark glasses may ease symptoms
• Symptoms sometimes respond to sensory tricks such as touching the corner of the eye
Oromandibular dystonia Jaw, tongue and mouth • Strange movements of face and mouth
• In some cases, eating and swallowing difficult
• Can be jaw open / jaw closed mix
• Tongue protrusion or twisting
• Damage to the jaw
• Tic
• Bruxism (teeth grinding)
• Dental problem
• Orthopaedic problem
• Psychological problem
• Does not respond to orthopaedic procedures
• No damage shows up on x-rays
• Does not clear up over time
• Movement still present when patient unaware of being observed
Laryngeal dystonia or spasmodic dysphonia  Vocal cords • Affects speech – voice either strangled or breathy • Throat cancer
• Acid reflux
• Nerve damage
• Psychological problem
• Tests or scans of throat negative
• Does not clear up over time
Focal hand dystonia Forearm and hand (also called writer’s cramp) • Hand/fingers contort, twist or go into spasm when used
• Often specific to tasks
• Orthopaedic problem
• Tendonitis
• Psychological problem
• Not usually present all the time
• Tends to be task specific  such as writing or playing a musical instrument
Myoclonus dystonia Neck, trunk and arms • Jerky movements combined with other symptoms of dystonia
• Usually upper limbs and neck/trunk 
• Psychological problem

• Family history of similar problems
• Writer's cramp quite common
• May be associated with compulsive disorders

Paroxysmal
Dystonia
All or part of the body • Episodes of dystonia or dyskinesia lasting minutes to hours
• Between episodes no sign of a problem
• Psychological problem
• Epilepsy
• Stroke
• Family history of similar problems
• Patient usually does not lose consciousness during an episode
Tardive dystonia One or more of face, tongue, trunk, neck, arm, leg •    Face and/or tongue movements
•    Spasms of trunk, neck, arm and/or leg
•    Psychological problem
•    Epilepsy
•    Chorea
•    History of having been prescribed antipsychotic or antiemetic medication
•    History of illegal drugs

 

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