Diagnosis:
Clinical
Focal dystonia: i.e. dystonia involving 1 region
Types:
- Blepharospasm: involuntary bilateral eye closure
- Oromandibular dystonia
- Spasmodic dysphonia
- Cervical dystonia:
- Spasmodic (intermittent) or sustained
- Torticollis: turned/rotated
- Retrocollis: extended
- Anterocollis: flexed
- Laterocollis: tilted
- Focal hand dystonia
- Task specific dystonia:
- Writers cramp (graphospasm), piano players cram, guitar players cramp, golf, running
Investigations to consider:
Consider:
- MRI if accompanied by other signs
- EMG/nerve conduction studies in equivocal cases
Treatment:
- Trial of levodopa (for dopa responsive dystonia)
1st line, for cervical dystonia, blepharospasm, oromandibular dystonia, spasmodic dysphonia & hand dystonia:
- Botulinum toxin A injection every 3 months
- Into forarm muscles for hand dystonia
- 2nd line:
- Anticholinergics: e.g. Trihexyphenidyl or benztropine
- Others:
- Clonazepam, Baclofen or Carbamazepine CBZ
- Diazepam
- Phenothiazines: haloperidol, tetrabenazine
- Consider nerve section in very refractory cases of spasmodic torticolis