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Feature Article

Detecting dystonia in general practice

ALESSANDRO F. FOIS, FLORENCE C.F. CHANG

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Abstract

Dystonia is an under-recognised movement disorder, characterised by involuntary twisting movements and postures. Diagnosis and treatment are often delayed. Early referral to a movement disorder neurologist is recommended to initiate treatment for this disabling condition.

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Key Points

  • Dystonia may affect a single body part and fluctuate in its manifestations, both between consultations and during the consultation – affected patients may easily be mistaken as having a psychogenic illness or being ‘worried well’.
  • Dystonia may be functionally disabling, even when only a single body part is affected (e.g. involuntary eye closure or neck turning that prevents driving).
  • Safe and effective treatment is available for focal dystonia in the form of botulinum toxin injections every two to three months – referral to a neurologist is recommended.
  • Antidopaminergic antiemetic (e.g. metoclopramide, prochlorperazine) and antipsychotic (e.g. haloperidol, risperidone) medications are an important cause of tardive dystonia. These medications should be prescribed with care as long-term exposure can cause permanent and disabling tardive dystonia.

    Picture credit: © Science Source/George Mattei/Diomedia.com
    
Model used for illustrative purposes only

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