Dystonia is a disorder that causes muscles to move on their own involuntarily. This muscle movement can occur in one limb to the whole body. As a result of this muscle movement, people with dystonia have a strange posture and experience tremors.
Dystonia itself is not a disease that is often encountered. It is noted that this disease affects 1% of the world's population, with more women than men. Unfortunately, there is still no data regarding the incidence of dystonia in the Asian region, especially in Indonesia.
Causes of Dystonia
The cause of dystonia is not clearly known, but it is thought to be related to inherited genetic disorders. But there are various factors that trigger dystonia, such as:
- Disorders of the nervous system, such as Parkinson's disease, multiple sclerosis, cerebral palsy (cerebral palsy), brain tumors, and stroke.
- Infections, such as HIV and inflammation of the brain (encephalitis).
- Wilson's disease.
- Huntington's disease.
- Medications, such as drugs to treat schizophrenia and anti-seizures.
- Head or spinal injuries.
The use of the drug donepezil in patients with Alzheimer's disease is also thought to trigger neck dystonia.
Symptoms of Dystonia
Symptoms of dystonia vary widely, depending on the part of the body affected, including:
- Twitch
- Shaking (tremor).
- The limb is in an unusual position, for example a tilted neck (torticollis).
- Muscle cramp.
- Eyes blink uncontrollably.
- Speech and swallowing disorders.
These symptoms can appear as a child (early dystonia) or as an adult (late dystonia). Symptoms that appear in early dystonia more often affect the limbs and spread to other parts of the body. While dystonia that occurs slowly is often limited to one limb, especially the face or neck area.
Dystonia Diagnosis
To diagnose dystonia, the neurologist requires several steps to determine the trigger for the dystonia. The doctor will ask questions such as:
- Age when symptoms first appeared.
- Massage the affected body part.
- Is the disease worsening rapidly.
After that, the patient will be advised to undergo the following additional tests:
- Urine and blood tests. This test aims to check the presence or absence of infection or toxic compounds in the patient's body, as well as to assess the overall function of the body's organs.
- Magnetic resonance imaging (MRI). This imaging test is useful for checking for abnormalities in the brain, such as strokes and brain tumors.
- Electromyography (EMG). This test is used to assess the electrical activity in the muscles.
- Genetic testing. DNA sampling is used to find out if the patient has a genetic disorder associated with dystonia, such as Huntington's disease.
Dystonia Treatment
Until now there is no known treatment that can cure dystonia. However, there are several treatments to reduce the frequency and severity of symptoms, including:
- Drugs. The drugs given are drugs that affect signals in the brain. Some drugs that can be given:
- Trihexyphenidyl
- Diazepam
- Lorazepam
- Baclofen
- Clonazepam
- Injection bautox (botulinum toxin). This medicine will be injected directly into the affected area and needs to be repeated every 3 months.
- Physiotherapy. The doctor may also suggest doing physiotherapy, to retrain the affected muscles.
- Operation. The type of surgery that doctors recommend is to install a special device to deliver electric current to the brain (deep brain stimulation), or cutting the nerves that regulate the affected muscles (selective denervation and surgery).
Dystonia Complications
There are several complications that can be experienced by people with dystonia, including:
- Difficulty to do daily work because of having obstacles in moving.
- Difficulty swallowing or speaking.
- Difficulty in seeing, if dystonia attacks the eyelids.
- Psychological problems, such as anxiety disorders or depression.