Dystonia After A Brain Injury

Disclaimer: This information sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

What is it?

Dystonia is a movement control problem and is not uncommon after an injury where there has been damage to the area of the brain called the basal ganglia. It is a movement problem that can occur after a brain injury, and refers to repetitive twisting, abnormal posturing or the `locking in' to positions by the body or a body part such as the neck, mouth, trunk, or a limb. It is caused by abnormal signals from the brain to the muscles. These wrong messages result in sustained muscle contractions. Dystonia is made worse with voluntary movement; at rest and when asleep the muscles are relaxed and appear normal.

Dystonia can vary in severity from mild to severe. It can be focal involving just one muscle group or body part, or it can be generalised involving the whole body. It can be present alongside other motor problems such as spasticity, and its presence may not always be readily recognised.

This particular motor disorder can have a delayed onset, eg weeks or even months after a brain injury. Dystonia may sometimes become more pronounced, or more entrenched, over time, which can cause loss of motor skills. Severe dystonia can lead to pain, joint damage and deformity.

What is the treatment?

Dystonia is not a well-understood problem, and it can be a very difficult and frustrating to treat. This is despite any skill of the therapist or the frequency of therapy or of doing exercises. Therapy techniques that can work well for other movement problems such as spasticity and weakness often do not work for individuals with dystonia.

Dystonia makes it difficult for a person to control his or her own dystonic posturing, and efforts to do so often make the problem worse, so the more they try and control their posture, the more locked in they may become, or the more out of control the limb gets. Some individuals are able to develop their own techniques (triggers) for managing their dystonic posturing and, therefore it is possible for some individuals to gain some control.

The presence of dystonia can cause difficulties with the fitting, making and wearing of splints or orthoses, and creative solutions are often needed. Protective splints to minimise pain, joint damage, and for functional benefits can be useful and important in the management of dystonia. Lycra garment splinting may be worth trialing as it can work well for some individuals, especially in the upper limb and trunk.

Medical treatments

Focal dystonias can sometimes be relieved by botulinum toxin injections.

Generalised dystonia may respond to oral drug treatments such as L-dopa, baclofen, benztropine, benhexol, and others. Generalised dystonias are best treated with oral or intrathecal medications. Intrathecal baclofen is a relatively new, expensive but effective treatment for severe generalised spasticity and dystonia.

Consult your rehabilitation specialist who will discuss possible treatment options.

See also:

• botulinum toxin injections
• intrathecal baclofen
• oral baclofen

Rehabilitation Department The Children's Hospital at Westmead Cnr Hawkesbury Rd & Hainsworth St, Westmead Locked Bag 4001, Westmead, 2145 Tel: (02) 9845 2132 - Fax: (02) 9845 0685 http://www.chw.edu.au/rehabilitation/