Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- simultaneous contraction of agonist and antagonist muscles
- muscle pain
- appearance or worsening of dystonia with action
- blepharospasm
- cervical torticollis
- hand spasms
- foot spasms
- acute presentation (within 5 days of exposure to antidopaminergic agent)
- acute worsening of pre-existing generalised dystonia
Other diagnostic factors
- twisting of the affected body part
- geste antagoniste (sensory trick)
- spread to another body part
- parkinsonism
- myoclonus
- tremor, weakness, or spasticity
- reflex sympathetic dystrophy
- Kayser-Fleischer rings on slit-lamp examination
Risk factors
- FHx of dystonia
- repetitive activity of affected region
- birth injury and delayed development in childhood
- exposure to antidopaminergic agents
- trauma
- genetic mutation
- Ashkenazi Jewish ethnicity
- structural lesion of the basal ganglia
- parkinsonian syndrome
Diagnostic investigations
Investigations to consider
- cranial MRI
- serum ceruloplasmin
- 24-hour urine copper
- DYT1 gene testing
Treatment algorithm
Contributors
Authors VIEW ALL
Assistant Professor of Neurology
Beth Israel Deaconess Medical Center
Harvard Medical School
Boston
MA
Disclosures
LCS is an unpaid secretary/treasurer at the Tremor Research Group. LCS receives funding from the NIH Dystonia Coalition project for participant enrollment.
Director of the Huntington's Disease Clinic
Instructor of Neurology
Parkinson's Disease and Movement Disorders Center
Beth Israel Deaconess Medical Center
Boston
MA
Disclosures
SF is employed by the Beth Israel Deaconess Medical Center, which has received funding from Allergan to support partial fellowship training.
Dr Ludy C. Shih and Dr Samuel Frank would like to gratefully acknowledge Dr David K. Simon and Dr Daniel Tarsy, previous contributors to this monograph. DKS has received consulting fees from the Gerson Lehrman Group. DKS is an author of a reference cited in this monograph. DT has received an unrestricted grant from Allergan and Medtronic being used for education. He received unrestricted funds for patient education from Allergan, Boehringer Ingelheim, Valeant, and Teva Neurosciences. He has received research funds from Solvay and Neurogen. DT is an author of a number of references cited in this monograph.
Peer reviewers VIEW ALL
Reader in Clinical Neurology
Honorary Consultant
Institute of Neurology
National Hospital for Neurology and Neurosurgery
London
UK
Disclosures
PDL declares that she has no competing interests.
Assistant Professor
Director
Movement Disorder Center
Dept of Neurology
University of Florida
Tampa
FL
Disclosures
ZH has been a consultant for Allergan and a speaker for Novartis and TEVA.
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