Dystonia is a hyperkinetic movement disorder characterized by sustained or intermittent muscle contractions that cause abnormal repetitive movements, abnormal postures, or both. The treatment options for dystonia include drugs, botulinum toxin and deep brain stimulation surgery.
In most cases the cause for dystonia is unknown. In a small number of patients, trauma precedes the onset of the dystonia. Significant head trauma is a well-recognized precipitating factor in dystonia. (Frei, 2017) Secondary dystonias are caused by underlying disease and may be inherited (a known genetic origin) or acquired. Acquired secondary dystonias include neurodegenerative disorders (such as Parkinson’s disease and multiple-system atrophy), traumatic and perinatal brain injury, diseases of the brainstem (for example, hypoxia, stroke, tumors, or multiple sclerosis), and the side effects of drugs, particularly antipsychotic medications. (Britton, 2020)
Focal dystonia affects a specific body part. For example, Limb dystonia (LD) refers to dystonia affecting one arm or leg. Lower limb dystonia in adults is rare as a primary cause, and parkinsonism or other neurological diseases must always be ruled out. (Pont, 2010)
When a dystonia is limited to the orofacial structures, it is called oromandibular dystonia (OMD) and the clinical presentation may include irregular jaw opening, closing and/or excursive movements. Patients may complain non-specifically of muscular tension and fatigue within the facial and masticatory muscles, and headaches, depression, anxiety, and sleep disturbance may also be prominent. (Britton, 2020)
Batla A. Dystonia: A review. Neurol India. 2018 Mar-Apr;66(Supplement):S48-S58. doi: 10.4103/0028-3886.226439. PMID: 29503327.
Pont-Sunyer C, Martí MJ, Tolosa E. Focal limb dystonia. Eur J Neurol. 2010 Jul;17 Suppl 1:22-7. doi: 10.1111/j.1468-1331.2010.03046.x. PMID: 20590804.
Hassell TJW, Charles D. Treatment of Blepharospasm and Oromandibular Dystonia with Botulinum Toxins. Toxins (Basel). 2020 Apr 22;12(4):269. doi: 10.3390/toxins12040269. PMID: 32331272; PMCID: PMC7232182.
Frei K. Posttraumatic dystonia. J Neurol Sci. 2017 Aug 15;379:183-191. doi: 10.1016/j.jns.2017.05.040. Epub 2017 May 23. PMID: 28716238.
Pandey S, Sharma S. Meige's syndrome: History, epidemiology, clinical features, pathogenesis and treatment. J Neurol Sci. 2017 Jan 15;372:162-170. doi: 10.1016/j.jns.2016.11.053. Epub 2016 Nov 23. PMID: 28017205.
Britton D, Alty JE, Mannion CJ. Oromandibular dystonia: a diagnosis not to miss. Br J Oral Maxillofac Surg. 2020 Jun;58(5):520-524. doi: 10.1016/j.bjoms.2020.02.018. Epub 2020 Mar 3. PMID: 32143935.