neurologic disorders
Dystonias
Introduction
Dystonias are sustained involuntary muscle contractions of antagonistic muscle groups in the same body part, leading to sustained abnormal posturing or jerky, twisting, intermittent spasms that can resemble tremors, athetosis, or choreoathetosis. Dystonias can be primary or secondary and can be generalized, focal, or segmental. Diagnosis is clinical. Botulinum toxin injections are used to treat focal or segmental dystonias. Treatment of severe generalized dystonia may require a combination of oral anticholinergic drugs, muscle relaxants, and benzodiazepines. Severe segmental or generalized dystonia that is refractory to treatment may require surgery. (See also Overview of Movement and Cerebellar Disorders .) Dystonia may be Primary (idiopathic) Secondary to central nervous system (CNS) disorders or drugs CNS disorders that can cause dystonias include Wilson Disease None Pantothenate kinase‒associated neurodegeneration [PKAN] associated withPANK2mutations [previously, Hallervorden-Spatz disease] Various lipidoses Multiple Sclerosis (MS) None Cerebral Palsy (CP) None Overview of Stroke None Brain hypoxia Drugs that most commonly cause dystonias include Antipsychotics (eg, phenothiazines, thioxanthenes, butyrophenones) Antiemetics (eg,metoclopramide,prochlorperazine) Dystonia may resemble Chorea, Athetosis, and Hemiballismus and choreoathetosis and should be distinguished from them because etiology and management may differ. 