Program of Attention to Distonias
Dystonia is a neurological syndrome characterized by involuntary, stereotyped and repetitive muscular contractions of opposing muscles, of tonic or spasmodic type, which frequently determine strains and other abnormal postures and movements.
These dystonic movements are usually continuous and sustained, but their duration and intensity can be modified by several factors:
emotion, fatigue, relaxation, motor activity, sensory stimuli and sleep. The severity of movements and dystonic postures varies from confused or little marked symptoms, which are only evident during the action, to incapacitating muscle spasms that prevent the execution of voluntary motor acts, with a typical tendency to recruit the adjacent musculature and fixation of abnormal postures due to segmental contractures.
In correspondence with the localization of the muscles involved, dystonias are usually classified as focal, segmental, hemidistonic and generalized dystonias. The latter, also known as deforming muscular dystonias, have a characteristic evolutionary profile that includes, frequent onset by a lower limb, with dystonic postures that only appear associated with the action and that progressively extend axially, until in a period of 5-10. years compromise the trunk and cause scoliosis, kyphosis, lordosis and opisthotonic postures. Its course is inexorably progressive and until now no pharmacological treatments have been found that stop the course of the disease or satisfactorily control spasms and dystonic postures.
Although it is still unknown how the Nervous System produces these dramatic motor abnormalities, some advances in the neural mechanisms involved suggest new therapeutic perspectives.
On the other hand dystonia can coexist with tremor, two basic types of tremor can be observed in patients with dystonia, postural and dystonic. It is possible that the tremor associated with dystonia is actually a frustrated form of dystonia. In some patients, tremors of the head and trunk (usually slow at frequencies of 1-5 Hz) may precede the initiation of dystonia and be the initial manifestation of focal dystonia. Rarely, cerebellar and parkinsonian tremors may be associated with dystonia and dystonia may be the card of Parkinson's presentation.