One way to classify dystonia is to divide causes into idiopathic dystonia, inherited dystonia and acquired dystonia. In idiopathic dystonia there is no identifiable cause of the dystonia and no degeneration or structural damage to the brain. In inherited dystonia, the person affected is known to have inherited a gene causing dystonia but there is no other degeneration or structural damage. Most people with the commonest forms of dystonia such as neck (cervical) dystonia and eye dystonia (blepharospasm) have idiopathic dystonia. In acquired dystonias, the dystonia is caused by damage or degeneration of the brain (for example after brain injury or stroke) or exposure to particular drugs.

There are more than 50 other causes of secondary dystonia affecting many thousands of people. This article will discuss some of the main ones.

Dystonia caused by brain injury/damage

Dystonia can sometimes appear after trauma to the brain via physical injury, or stroke. Where the injury is to the head, the symptoms often affect the side of the body which is opposite to the side of the brain injured. The injury can often result in observable damage (lesions) in the brain that can be seen using neuroimaging techniques such as MRI scans. This contrasts with primary dystonia where no abnormalities of the brain can be seen.

Dystonia can also result from an injury to a part of the body other than the brain: for instance neck dystonia sometimes follows whiplash, eye dystonia (blepharospasm) can follow eye surgery and mouth dystonia (oromandibular) can follow dentistry work. Post-traumatic dystonia can sometimes be distinguished from primary dystonia because the symptoms may not respond to sensory tricks and may persist during sleep. Symptoms may also be paroxysmal which means they occur in episodes rather than being constant.

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Parkinson’s disease and dystonia

Parkinson's disease is a neurological movement disorder with a wide range of symptoms including slowness of movement, rigidity of muscles, memory impairment and others. Both Parkinson’s disease and dystonia can arise in the same person because they seem to originate in the same part of the brain: the basal ganglia. Sometimes symptoms similar to Parkinson’s disease (parkinsonism) arise together with dystonia due to a genetic defect as in the rare condition, x-linked dystonia parkinsonism.

However, the most common cause of dystonia in Parkinson’s patients is a secondary dystonia arising from the effect of treating Parkinson’s disease using the medication, Levodopa.

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Cerebral palsy and dystonia

Cerebral palsy is an umbrella term for a group of movement and posture disorders that occur as a result of damage to the developing foetal or infant brain. Causes can include premature delivery and birth injuries.

Dystonic cerebral palsy is caused by damage to the basal ganglia or cerebellum and causes dystonic symptoms such as involuntary muscle spasms and slow, rhythmic, twisting movements. The condition is clearly distinct from spastic cerebral palsy because the muscle tone switches from floppy and loose to tight rather than staying tight all the time. There can also be difficulty controlling the tongue and vocal cords. As with childhood-onset primary dystonias, treatment is usually through a variety of medications and sometimes botulinum toxin. However, Deep Brain Stimulation which is often effective for primary dystonias is not generally used for secondary dystonias.

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Metabolic disorders and dystonia

Metabolic disorders arise when the body fails to process the chemicals in the body properly. This can result in excesses or deficiencies of materials arising in different parts of the body. Dystonia is one of the conditions that can occur when these metabolic disorders affect the brain. There are more than 50 different metabolic conditions that can cause dystonia but most of them are extremely rare.

Examples include Wilson’s disease which is a treatable genetic condition in which the body does not process copper properly and neuronal brain iron accumulation syndrome (NBIA) – a genetic degenerative condition in which iron is deposited in the basal ganglia.

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Drug-induced dystonia (tardive dystonia)

Click here to read more on drug-induced (tardive) dystonia.

Note: This article was prepared with the guidance of Dr Mark Edwards and using information from Parkinson's UK, Scope and the DMRF.


The Dystonia Society provides the information on this page as general information only. It is not intended to provide instruction and you should not rely on this information to determine diagnosis, prognosis or a course of treatment. It should not be used in place of a professional consultation with a doctor.

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