What is Focal Dystonia?
Focal dystonia is an unusual neurological condition, which is also referred to as “the yips,” characterized by involuntary spasms in the small muscles.1 The cause of Focal Dystonia could be repetitive or overuse stress. People who commonly experience Focal Dystonia include golfers and musicians. The hands also get affected with focal dystonia due to which the patient’s fingers involuntarily extend outwards or curl into the palm.
Focal dystonia is considered a common neurological problem and affects about 30 in every 100,000 people in the United States. Focal dystonia can affect people of all ages, including kids; however, symptoms of focal dystonia usually appear between the ages of 40 and 60 years.
What are the Causes & Risk Factors of Focal Dystonia?
- Primary Focal Dystonia occurs when there is insufficient or the wrong type of production of neurotransmitters by the basal ganglia.2
- Focal Dystonia can also be hereditary.
- Secondary dystonia develops as a result of some other neurological condition or some environmental causes can trigger it.3 Secondary dystonia can develop from a birth injury which causes hypoxia or brain hemorrhage. The baby can also develop stroke later in life.
- Other causes of focal dystonia include some infections, exposure to certain substances, certain medications, carbon monoxide and heavy metal poisoning.
- Environmental and task-related factors can also cause focal dystonia.
- Individuals who perform high precision hand movements, such as engineers, musicians, artists and architects are at increased risk for developing focal dystonia. Musician’s dystonia is a type of Focal dystonia.
- Focal dystonia can also be “task specific,” which means the patient experiences its symptoms only when performing certain activities.
- Musicians such as violinists are more prone to focal dystonia.
- Risk factors of Focal dystonia include anxiety or “choking” which many sports people experience during high-pressured competitions and over strain of the muscles.
- Patients who are already suffering from neurological conditions, such as Huntington’s, Parkinson’s or Wilson’s disease can develop secondary focal dystonia.
- Patients with cerebral palsy and multiple sclerosis (MS) can also develop focal dystonia.
What are the Symptoms of Focal Dystonia?
Loss of precision in muscle coordination is one of the initial symptoms of focal dystonia. Patient initially starts to notice increasing difficulty in using a pen, which then progresses to experiencing minor injuries to the hands. The patient then is unable to hold things and starts to drop them.
Increased muscle usage produces trembling and cramping pain.
Patient also experiences considerable muscle cramping and pain from minor activities, such as holding a book or turning the pages.
Other than the direct symptoms, patient can also experience secondary symptoms from persistent muscle and brain activity. These secondary symptoms of focal dystonia include: disturbed sleep, mood swings, exhaustion, mental stress, blurred vision, irritability, difficulty concentrating, digestive problems and short temperedness.
Patients suffering from focal dystonia can also start feeling depressed and as there is worsening of focal dystonia, the patient finds it difficult perform daily activities of living.
In some cases, the symptoms of focal dystonia worsen and then stabilize for many years. Whereas, in some patients, the symptoms of focal dystonia stop progressing entirely.
Treatment and lifestyle changes help in slowing the symptoms of focal dystonia. However, if the patient continues to use his/her muscles like before, then the symptoms of focal dystonia tend to progress faster.
How is Focal Dystonia Diagnosed?
Electromyography (EMG) is a test where electrical sensors are used for diagnosing focal dystonia. If the patient is told to perform an intentional activity, then the patient’s muscles tire rapidly and there are certain parts of the muscle groups, which do not respond resulting in weakness. Then there are some parts of the muscle groups which become rigid or over-respond.
How is Focal Dystonia Treated?
- It is important for the patient to make lifestyle changes, such as cutting down on the movements which worsen or trigger the symptoms of focal dystonia.
- Other lifestyle changes for combating the symptoms of focal dystonia include decreasing stress, moderate exercise daily, plenty of rest, and relaxation techniques.
- Botox injections help in relieving the symptoms of Focal dystonia though they are not a cure. Botox injections are given directly into the affected muscles where they stop the neurotransmitters, which cause the muscle spasms in focal dystonia. The effect of Botox injections commonly lasts for about 3 months after which the patient needs another Botox injection.
- Clonazepam is an anti-seizure medicine which, however, has a limited effect. The adverse reactions of Clonazepam include sedation, mental confusion, short-term memory loss and mood swings.
- Anticholinergics are a type of medication which help in treating some types of focal dystonia and help give relief to some patients. Anticholinergics act by blocking the release of acetylcholine, which is a neurotransmitter.
- A non-psychoactive cannabidiol found in Cannabis also can be given to the patient to decrease the symptoms of Focal dystonia. However, research is still going on as to the use of this in focal dystonia.
What is the Prognosis for Focal Dystonia?
Focal Dystonia is a disorder which persists for the patient’s entire life and very few patients experience a remission. The life expectancy of the patient with focal dystonia is normal, however; the symptoms of focal dystonia will persist which means the patient will have to restrict certain activities. The patient needs to learn to live with focal dystonia and with the help of their doctor, the patient can manage the symptoms of focal dystonia and adapt their posture and movements accordingly.
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