Trauma
Dystonia symptoms may follow trauma to the head, and/or trauma to a specific body area.Dystonia symptoms following head trauma often affect the side of the body which is opposite to the side of the brain injured by the trauma. Examples of peripheral injury include oromandibular dystonia following dental procedures, blepharospasm following surgery or injury to the eyes, and cervical dystonia following whiplash or other neck injury. Symptoms of trauma-induced dystonia may be paroxysmal (meaning that they occur in episodes or “attacks” of symptoms), not respond to sensory tricks, and persist during sleep.
Brain trauma will often manifest in observable lesions in the brain that can be assessed by neuroimaging techniques. Onset of symptoms may be delayed by several months or years after trauma. Clues to whether dystonia to a specific body part can be attributed peripheral injury to that body area include:
- The injury is severe enough to cause local symptoms that persist for at least two weeks or require medical evaluation within two weeks;
- The onset of the movement disorder occurs within a few days or months (up to a year) after the injury;
- The symptoms relate anatomically to the injured part of the body.
In addition to dystonia, movement disorders that are believed to result from brain and peripheral trauma include parkinsonism, tremors, chorea, myolconus, tics, and hemifacial or hemimasticatory spasm.
Terms used to describe trauma-induced dystonia include: injury-induced, peripherally-induced (when trauma is to affected body area, not brain), post-traumatic dystonia, causalgia-dystonia syndrome, reflex sympathetic dystrophy with dystonia
Diagnosis
Many of the ascribed causes of secondary dystonia are based on historical information or subtle characteristics of the symptoms, and have no diagnostic, radiologic, serologic, or other pathologic trademark.
Treatment
Oral medications are often the mainstay of treatment for secondary dystonia. Although there is no single drug that helps an overwhelming number of individuals, there are several that may be of benefit. These oral medications include levodopa, trihexyphenidyl, clonazepam, and baclofen (oral and intrathecal—especially for dystonia and spasticity). Medications may be taken in combination.
Botulinum toxin injections may be used to treat specific body parts that may be affected, such as the neck, jaw, hands, or feet.
Several surgical techniques may be appropriate for select individuals who do not respond to medications and botulinum toxin injections. These include ablative surgeries such as pallidotomy and thalamotomy, intrathecal baclofen, and deep brain stimulation.
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