Movement Disorders

Movement Disorders and Dystonia Treatment

It is most unfortunate when someone suffering from a medical disorder, such as dystonia, is told to learn to live with it, or worse still, that their problem is in their head. Yet this seems all too common as many of our patients have been told these very things by other so called experts in the field in which they specialize.  I actually have folders full of MRI reports where the patients were alleged to be “uncooperative” because they would not stay still during the study.  Because dystonia is a rhythmic involuntary spasm of muscle groups, it is apparent to any observer, trained or untrained, that staying still is not an option.  In fact, it is the goal of the patient to one day be able to stay still.  Yet we continue to see so many patients who are told that they are not cooperating simply because of the doctor’s lack of knowledge in what they are dealing with.  Most horrifying, to say the least.  Yet it is a common occurrence amongst this group of movement disorder patients.  When you begin to understand the neurophysiology of these disorders one can truly demonstrate the deserved compassion for sufferers of dystonia and the family of movement disorders.

Dystonia Symptoms

Occasionally referred to as torticollis, which is a type of dystonia, dystonia is a type of neurological movement disorder characterized by involuntary muscle contractions, or spasms.  As far as movement disorders, dystonia is in the top three, with Parkinson’s disease and essential tremors.  Dystonia is not gender or race specific.  Frequently, certain parts of the body will be forced into abnormal, painful, movements or postures. Dystonia varies by affect and may involve any part of the body including the arms and legs, trunk, neck, eyelids, (blepharospasm), face, or vocal cords, (as a tic).

While dystonia is not fatal, it is a chronic disorder and prognosis is difficult to predict.  Impairment caused by dystonia is due to muscle contracture, which can interfere with normal function. Although cognition,  and the senses, including vision and hearing are technically normal, they are routinely affected both neurologically with progression of the disorder, as well as due to the inability to prevent movement, allowing continual over correction to be made with the eyes.  With progression of the disorder, twisted postures associated with the muscle spasms affecting limbs and trunk, bizarre walking with bending and twisting of the torso, rapid and sometimes rhythmic jerking movements, and progression of symptoms leading eventually to sustained fixed postural deformities are not uncommon.  Needless to say, this is associated with significant pain.  Cervical dystonia is sometimes associated with a “no-no” or “yes-yes” tremor, causing the head to shake in an oscillatory fashion.

What is Blepharospasm?

Blepharospasm is an abnormal, involuntary blinking or spasm of the eyelids.

Orthostatic Tremor

Primary orthostatic tremor is a rare movement disorder characterized by high frequency tremors of the legs when standing, (13-18 Hz) causing severe contractions of the muscles of both legs simultaneously. The tremor worsens the longer the patient tries to stand without movement.  This disorder is very often misdiagnosed as other neurological problems such as Parkinson’s, MS etc.  The tremor disappears partially or completely when an affected person is walking or sitting. Individuals with primary orthostatic tremor experience feelings of unsteadiness or imbalance.

Essential Tremor

Essential tremor is the most common neurologic movement disorder.  Essential tremor is a chronic condition characterized by involuntary, rhythmic tremor of a body part, typically the hands and arms.  Hand tremor is the most common form of essential tremor. It  involves agonist and antagonist muscles and is usually, but not always, bilateral.  Essential tremor may progress to involve the head, followed by the voice, tongue, legs, or trunk. The movements associated with head tremor usually occur in a horizontal “no-no” pattern.  Head tremors may also occur in a vertical “yes-yes” pattern.

  • Static or Resting Tremor

Resting tremor occurs when a body part is at complete rest against gravity. Tremor amplitude decreases with voluntary activity.

  • Kinetic or Intention Tremor

Kinetic tremor occurs during voluntary movement. Intention tremor manifests as a marked increase in tremor amplitude during a terminal portion of targeted movement.

  • Postural Tremor

Postural tremor occurs during maintenance of a position against gravity and increases with action.

Research Based Non-surgical Treatment for Dystonia

Recent research by Frederick Carrick, DC, PhD, DACNB proved the tremendous effect chiropractic neurologists can have on cervical dystonia when managed in accordance to brain based neurology. The study included 111 subjects in a clinical setting. Patients were treated as determined by physiologic blind spot mapping of the eyes and other neurologic findings. Each subject was treated an average of six times. Follow-ups two months later rated 67.6% had at least a 50% improvement in movement, 55.2% had at least a 50% reduction in tremors, 57.7% had at least a 50% decrease in muscle spasticity and 77.5% had at least a 50% decrease in pain. These results are outstanding and provide hope for dystonic patients looking for non-surgical treatment options.

Botulism Toxin Injections for Dystonia

It is most unfortunate for most, that it is typically the first order of treatment to render botulism toxin injections for treatment of dystonia.  These injections, which are only temporary at best, should obviously be reserved for secondary treatment following failed more conservative measures, or, in conjunction with conservative measures.  Botulism toxin is not curative.  If it works at all, it is temporary and must be performed continually with expression of symptomatology.

Actual Case of Myoclonic Dystonia Tremor Treated Without Drugs Or Surgery

This Patient video is of a 27 year old female suffering with myoclonus dystonia. The first half of the video is from her initial examination with me.  She was apparently told by another alleged expert in movement disorders that her condition was in her head and to see a psychiatrist.  The second half of the video demonstrates a marked reduction of myoclonic dystonic tremor of better than 80% after only two weeks and five treatments with me.

Treatment of Patient With Myoclonus Dystonia

We have seen many similar miraculous recoveries from this dreadful disorder, dystonia.  As many of our patients are from out of state, we oftentimes do not have the opportunity to take “after” videos demonstrating the patients recovery.  In this case, this patient lives in NJ so we were able to get “after” videos which the patient was kind enough to allow us to share on our website.

Please reference our Treatment page for information on how our office manages patients with dystonia.

If you would like to schedule a free consultation, or just have questions, please contact us from our Contact page.

Copyright © 2004 Dystonia Medical Research Foundation.

Dr. Scopelliti is a Functional Neurologist in Monmouth County NJ.