Detecting dystonia in general practice


We recommend that these videos be watched in the context of the article in which it was published.

Cervical dystonia

Video 1. Cervical dystonia. This patient exhibits involuntary left head and neck turning, more pronounced when asked to close her eyes and let her head ‘move where it wants to go’. Even with eyes open she finds it difficult to keep her head in a neutral position for long, but is able to do so by using a geste manoeuvre, placing her hand on her cheek. See for the complete article.


Blepharospasm/Meige syndrome

Video 2. Blepharospasm/Meige syndrome. This patient has features of blepharospasm with excessive blinking at rest and occasional more forceful spasms of orbicularis oculi causing tight eye closure, particularly seen when speaking. In addition, he has forward flexion of his neck (anterocollis), dystonic involuntary lower facial grimacing movements, and ‘strangled’ speech with frequent breaks (spasmodic dysphonia). Some of these features are alleviated by placing his hand on his chin (geste manoeuvre). This combination of blepharospasm and oromandi-bular dystonia is known as Meige syndrome. See for the complete article.


Writer’s cramp

Video 3. Writer’s cramp. This patient has features of writer’s cramp with frequent pausing and lifting of his right hand when writing. The right shoulder slowly abducts and the right wrist slowly extends as he writes each word. He has some subtle mirror dystonic movements with extension of the wrist and fingers in the right hand when writing with his left hand. See for the complete article.


Spasmodic dysphonia

Video 4. Spasmodic dysphonia. This patient has a ‘strangled’, tremulous voice, with the tremor most obviously heard during prolonged phonation of the ‘aaaa’ sound and pronouncing  the ‘a’ vowel during spontaneous speech. Speech when whispering is relatively normal, thus demonstrating task specificity of the speech disorder, a feature that is characteristic of spasmodic dysphonia. See for the complete article.