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Specialists in the Field of Dystonia Therapy
Kliniken Schmieder Allensbach and Heidelberg
Acute Neurology, Neurological Early Rehabilitation and Rehabilitation, Neuroradiology and Radiology
Information About the Field of Dystonia Therapy
What Is Dystonia?
Dystonia is a dysregulated state of tension of individual muscles, which is associated with cramps and incorrect postures of the body and can occur at any age. As a result, uncontrollable movements and unusual postures can occur, leading to pain and reduced quality of life for the affected patients. In addition, ordinary everyday tasks are sometimes complex or impossible, resulting in considerable suffering.
The clinical picture is caused by a disturbed signal transmission from the brain's movement centers to the muscle groups, which reduces fine-tuning of the movement sequences.
What Are the Different Forms?
Dystonia can be differentiated based on its localization. The most common group is focal dystonia, limited to individual body regions.
If the clinical picture affects two adjacent areas, it is called segmental; if it involves two or more locations, it is called multifocal.
On the other hand, generalized dystonia is usually more severe and often associated with a need for care because several body regions are affected.
If the muscles of one-half of the body are affected, this is called hemidystonia; if the entire trunk is twisted, it is called torsion dystonia.
A common manifestation is a torticollis. Here, due to cramping of the neck and neck muscles, a sideways twist, extension, or flexion of the neck is noticed.
In the case of eyelid cramps, blepharospasm, sufferers squint their eyes due to cramped eye muscles. This can cause patients to have difficulty opening their eyes or not opening them at all during this period.
Occupational dystonia is manifested, for example, by cramped hand muscles when writing so that patients have problems writing.
Vocal cord spasm describes the sudden contraction of the vocal cords when speaking, resulting in a jerky, clenched voice and the inability to articulate clearly.
There is usually no definite cause for the spasms; it is idiopathic. However, genetic components have been described.
Secondary dystonia can occur, for example, in Parkinson's patients whose disease is characterized by structural changes in the brain's movement centers. But it can also be triggered by medication, circulation disorder in the brain, or traumatic brain injury .
How Is Dystonia Diagnosed?
Based on the medical history, the patient can elicit tension states. Altered movement patterns, typical for dystonia, are also revealed in the physical examination. It is also determined whether the clinical picture occurs more frequently in the patient's family to shed more light on genetic components.
It is also important to exclude secondary causes such as metabolic diseases and brain damage. Imaging procedures such as computed tomography or magnetic resonance imaging can be used for this purpose.
Dystonia therapy has various therapeutic pillars. It should always focus on improving the quality of life and the functionality of the muscle groups and reducing pain. Complementary treatments such as physiotherapy , occupational therapy, and psychotherapy can help achieve the therapeutic goal.
Primarily, the drug approach is preferred. However, surgical procedures are used if the disease progresses or symptoms cannot be controlled sufficiently.
In the case of focal dystonia, treatment with botulinum toxin has been promising. The toxin, which initially comes from a bacterium, is injected into the muscle and makes the cramped muscles less responsive to excessive impulses. As a result, signal transmission is weakened, and the muscle relaxes. This condition can give the patient relief for several weeks to months. Subsequently, the injection must be repeated. However, after a longer duration of therapy, a habituation effect may develop with this method.
Anticholinergics have an anticonvulsant effect but are sometimes associated with severe side effects, which is why they are preferably used only for severe and generalized dystonia.
Muscle relaxants or benzodiazepines, antiepileptics, and also analgesics also show efficacy.
Again, detailed attention should be paid to the side effect profile, as dystonia usually requires long-term treatment.
Surgical treatment may be considered for patients in whom drug therapy responds only inadequately or no longer at all.
This may be the case, for example, if treatment with botulinum toxin shows habituation effects and the dose can no longer be further increased or the dystonia is challenging to control with medication.
One option is deep brain stimulation , where electrodes are inserted into the brain under general anesthesia to deliver electrical impulses. This specifically inhibits active areas of interference in the brain to alleviate the condition.
Prognosis and Rehabilitation
Dystonia is primarily a non-curable condition, as no specific cause can usually be found. Accordingly, therapy aims to relieve symptoms and improve the patient's quality of life. Accompanying forms of treatment such as physiotherapy, occupational therapy, rehabilitation measures, and psychotherapy should always be considered.
Which Doctors and Clinics Are Specialized in the Diagnosis, Therapy, and Rehabilitation of Dystonia?
Since it is a neurological clinical picture, patients are treated by specialists in neurology. They can also examine and exclude corresponding neurological differential diagnoses. Furthermore, depending on the localization of the dystonia, it may be necessary to work together with ophthalmologists or ENT specialists on an interdisciplinary basis. The family doctor is also an important contact person.
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