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Semin Neurol 2023; 43(01): 017-034
DOI: 10.1055/s-0043-1764292
Review Article

Dystonias: Clinical Recognition and the Role of Additional Diagnostic Testing

Christopher D. Stephen
1   Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
,
Marisela Dy-Hollins
1   Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
,
Claudio Melo De Gusmao
2   Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
,
Xena Al Qahtani
1   Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
,
Nutan Sharma
1   Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
› Author Affiliations Funding C.D.S. is supported by NIH NINDS 1K23NS118045-01A1.
› Further Information
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Abstract

Dystonia is the third most common movement disorder, characterized by abnormal, frequently twisting postures related to co-contraction of agonist and antagonist muscles. Diagnosis is challenging. We provide a comprehensive appraisal of the epidemiology and an approach to the phenomenology and classification of dystonia, based on the clinical characteristics and underlying etiology of dystonia syndromes. We discuss the features of common idiopathic and genetic forms of dystonia, diagnostic challenges, and dystonia mimics. Appropriate workup is based on the age of symptom onset, rate of progression, whether dystonia is isolated or combined with another movement disorder or complex neurological and other organ system features. Based on these features, we discuss when imaging and genetic should be considered. We discuss the multidisciplinary treatment of dystonia, including rehabilitation and treatment principles according to the etiology, including when pathogenesis-direct treatment is available, oral pharmacological therapy, chemodenervation with botulinum toxin injections, deep brain stimulation and other surgical therapies, and future directions.

Keywords

dystonia - diagnosis - multidisciplinary treatment


Publication History

Article published online:
27 March 2023

© 2023. Thieme. All rights reserved.

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