Dystonia (muscle cramp)

Dystonia comes from Greek and meaning altered muscle tone by referring to a syndrome of sustained involuntary spasmodic muscle contractions involving co-contraction of agonists and antagonists.The movements are usually slow and sustained. Occurring but can be repetitive and unexpected fluctuente. Frequent abnormal positions and torque can be painful and debilitating functional.Depending on the cause of dystonic contractions may lead to an evolution of chronic and persistent pain with severe disability.Because each type of dystonia is treated in different manner, the difference between various types of treatment is important.Pseudodistoniile comprise a group of motor problems that are similar to the dystonic. In this category, Sandifer syndrome, stiff man syndrome and Isaac's syndrome.
Cervical dystonia or torticollis is the most common focal dystonia.Upper limb dystonia cause muscle cramps and abnormal position of the mind, fingers and elbow, leading to inability to perform certain movements. Lower limb dystonia occurs in stroke or dystonia-parkinsonism syndrome, leading to abnormal position of the leg pain with altered bone development. Musculorum deformans dystonia is the term used to define generalized dystonia of the limbs and trunk. Tardive dyskinesia or dystonia is a common complication of long-term therapy with antipsychotic dopamine receptor antagonism. The precise mechanism is unknown but the risk seems to increase with age.
In addressing the patient history and physical examination is important. Family history is important because over 44% of patients have such a positive track record for similar movements.Dystonia may be a clinical manifestation of many neurological diseases treatable. A number of drugs can induce acute dystonia.Common drugs that are antagonists induce dopamine, haloperidol, metoclopramide, antilepticele, phenytoin, carbamazepine, valproic acid, felbamat, levodopa, adrenergic agents, amphetamines, caffeine, beta-agonists, antihistamines, tricyclic antidepressants, lithium, cimetidine, oral contraceptives,cocaine.
Functional impact of dystonia varies from barely notifiable until severe disability. Dystonia may have a profound effect on personal and emotional life of his patient and the possibility of being independent. Options consist of medical therapy in rehabilitation therapy, oral medications, and surgical interventions neurochemolitice. Dystonia are often triggered or exacerbated by fatigue, anxiety, relaxation or sleep, intentional movements.Specific massage, light stretching and ultrasound techniques and biofeedback are sometimes helpful in people with focal dystonia or regional.
Medications can be helpful introduction to some extent in controlling dystonia, but the lack of accurate knowledge on the pathology of their specific pharmacologic therapy is difficult.Systemic administration of cholinergic therapies include benzodiazepines, antiparkinsonian, anticonvulsants. Successful pharmacologic therapy involves administration of drug combinations.Surgical options for dystonia include persistent severe spinal accessory nerve transsectia for torticollis, or palidotomia stereotactic talamotomia for generalized dystonia and muscle excision.
Pathogenesis and causes muscle crampsBlocking nerve inflows basal ganglia is considered to be the basis of dystonia. Lesions of the putamen are linked hemidistonii.Putamenului bilateral impairment is responsible for generalized dystonia. Torticollis and dystonia affecting the hand are determined by the head of the caudate nucleus and thalamus.Disease and disorder subtalamusului thalamus and hypothalamic function are also suspected. Because the basal ganglia play a role in maintaining normal posture of the head, vestibulo-ocular reflex pathways were involved in the development of cervical dystonia.The disorder is also described neurotransmitter system in dystonia. Blink reflex abnormalities suggest impaired central brain.Suspected brain trauma and upper limb.
Supersensibilitatea drug-induced abnormalities of dopamine neurons or GABAergic mechanisms are proposed for some drug-induced dystonia. Although supersensibilitatea is an inevitable complication of long-term therapies, antipsychotics, tardive dyskinesia is not always. Abnormalities of serotonin, dopamine and norepinephrine in specific brain structures have been associated with dystonia musculorum deformans.
Anatomical classification of dystoniaBased on the clinical distribution of dystonia can be classified into focal, segmental, multifocal, generalized or hemidistonii. Focal dystonia involves one area of ​​the body. Cervical dystonia or torticollis is the most common focal dystonia. Local limb dystonia dystonia begins as a voluntary action mediated by a specific, for example writing or dystonia dystonia musician. 30% of patients become focal segmental or multifocal dystonia.Segmental dystonia affects two or more continuous regions of the body. Examples of such craniocervicala dystonia is dystonia, blepharospasm, laryngeal dystonia oromandibulara and dystonia.Multifocal dystonia consists of anomalies in areas of the body that are not in continuity. Hemidistonia unilateral dystonia is also known as social contralateral basal ganglia abnormalities. Segmental crural dystonia generalized dystonia involving at least one party in the body. A generalized form of dystonia musculorum deformans or disease called torsion dystonia affecting the trunk and limbs.Dystonia can be classified according to age:Infantile dystonia begins before age 2 years.Childhood dystonia begins at the age of 2-12 years.Juvenile dystonia begins at 13-20 years and 20 years after adult dystonia.Etiological classification:Primary or idiopathic dystonia.This type occurs sporadically, autosomal recessive, autosomal dominant or X-linked recessive pattern. Childhood hereditary dystonia is common in Jewish people. Today more than 12 types of dystonia can be distinguished on the basis of genetics.Secondary dystonia.Arise through a variety of neurological diseases or inherited metabolic defects:, Huntington's disease, Hallervorden-Spatz diseaseWillson-disease, Leigh disease, ParkinsonismLipid-storage disease, central nervous system infectionsTumors or brain-cerebelare, drug intoxication-Structural or hypoxic injuries of the basal ganglia.
Common drugs that can cause muscle cramps are dopamine antagonists, haloperidol, metoclopramide, antilepticele, phenytoin, carbamazepine, valproic acid, felbamat, levodopa, adrenergic agents, amphetamines, caffeine, beta-agonists, antihistamines, tricyclic antidepressants, lithium, cimetidine, oral contraceptives, cocaine.