Synopsis
Recognise patterned twisting movement and posture, identify acute drug-induced and secondary causes and combine targeted injection, rehabilitation, oral and surgical treatment around function and pain.
- Dystonia consists of sustained or intermittent muscle contractions causing abnormal, often repetitive movements or postures that are patterned, twisting and sometimes tremulous.
- It may be focal, segmental, multifocal, hemidystonic or generalised and is classified further by age at onset, temporal pattern and whether it is isolated, combined or secondary.
- Movement is often action-induced and worsens with a specific task, fatigue or stress; overflow recruits nearby muscles and a geste antagoniste or sensory trick may transiently improve it.
Key red flags
Forceful blinking, jaw opening or closing, lower facial contraction or task-dependent strained or breathy voice reflects focal cranial network involvement; swallowing and airway impact determines urgency.
Investigation priorities
Demonstrate pattern, task dependence, overflow, mirror movement, null point and sensory trick and define the muscles causing disability.
Management branches
Painful oculogyric, jaw, neck, tongue, truncal or laryngeal posturing follows a dopamine-blocking medicine.
- Use ABCDE, identify stridor, tongue or jaw obstruction and swallowing compromise, call anaesthetic support for airway involvement and stop the suspected culprit.
- Give parenteral procyclidine through the emergency protocol, commonly 5 to 10 mg intramuscularly or intravenously in an adult, and reassess promptly for response and recurrence.
Key medicines
Procyclidine for acute dystoniaA common adult emergency dose is 5 to 10 mg intramuscularly or intravenously by protocol.
Botulinum toxin type AUse product-specific units, muscle selection and intervals, commonly around twelve weeks, through an expert clinic.