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Dystonia is characterized by involuntary muscle contractions and uncontrollable spasms, which are often repetitive and can cause unusual, strange and painful postures.
Muscular dystonia usually arises due to a brain problem in the nervous system, responsible for controlling muscle movement. This brain problem can be genetic or arise as a result of a disease or injury such as stroke, Parkinson's disease, blow to the head or encephalitis.
Dystonia has no cure, but muscle spasms can be controlled with treatment, which can be done with injections of botulinum toxin, known as botox, drugs, physical therapy or surgery.
Main symptoms of dystonia
Symptoms may vary according to the regions affected and the type of dystonia:
- Focal dystonia: affects only one region of the body, causing involuntary contractions and spasms in the affected muscles. A common example is cervical dystonia, which affects the neck, causing symptoms such as involuntary tilting of the neck forward, backward or sideways, with pain and stiffness;
- Segmental dystonia: affects two or more regions that are interconnected, as is the case of oromandibular dystonia, which affects the muscles of the face, tongue and jaw, which can cause facial distortion and the involuntary opening or closing of the mouth;
- Multifocal dystonia: affects two or more regions of the body, which are not interconnected, such as the left arm and the left leg, for example, causing involuntary muscle contractions in the affected muscle group;
- Generalized dystonia: affects the trunk and at least two other parts of the body. It usually begins in childhood or adolescence and begins with involuntary contractions in one of the limbs, which then spread to other parts of the body;
In addition, the person may also have hemidystonia, in which an entire side of the body is affected, causing involuntary spasms and muscle stiffness throughout that side of the body.
How the treatment is done
Treatment for dystonia has the main objective of controlling involuntary muscle contractions and, consequently, improving the person's appearance and quality of life.
The choice of treatment must be made by the doctor, according to the severity and type of dystonia:
1. Botox injections
Dystonia can be treated with injections of botulinum toxin, known as botox, as this substance helps to reduce the involuntary muscle contractions characteristic of this disease.
Botox injections are administered by the doctor directly to the affected muscles, usually every 3 months and it is normal to experience pain at the injection site for a few days. In addition, botox injections can cause other side effects, depending on the injection site, such as difficulty swallowing, in case of cervical dystonia, for example.
2. Remedies for dystonia
Drug treatment for dystonia may include the use of the following remedies:
- Levodopa and Carbidopa: used to improve involuntary spasms;
- Tetrabenazine: indicated for the treatment of diseases characterized by uncontrollable irregular movements;
- Triexiphenidyl: an anticholinergic remedy, which acts by blocking the release of acetylcholine, which is responsible for causing muscle spasms;
- Baclofen: relieves muscle stiffness and relaxes muscles;
- Diazepam and lorazepam: muscle relaxants, which promote muscle relaxation.
These remedies must be prescribed by the doctor, and the dose and method of use may vary according to the severity of dystonia.
3. Physiotherapy for dystonia
Physiotherapeutic treatment for dystonia consists of performing specific exercises or techniques to help maintain total movement, improve posture, relieve pain, avoid shortening or weakening the affected muscles and improve the patient's quality of life.
In addition, physiotherapy helps to prevent muscle contractures and reduce the side effects of botox treatment, by relieving pain or stimulating swallowing, for example, which can be compromised with botox.
4. Surgery for dystonia
Surgical treatment for dystonia can be done using two techniques:
- Deep brain stimulation: consists of implanting electrodes inside the brain that are connected to a small device, similar to a pacemaker, that is usually in the abdomen and that sends electrical impulses to the brain, helping to control muscle contractions;
- Selective peripheral denervation: consists of cutting the nerve endings that are causing muscle spasms.
These surgical options are usually only done when the other treatments have not been effective.