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Dystonic Tremor: How to Confront Jerky and Rhythmic Disruptions?

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Dystonic tremors are a movement disorder that leads to the involuntary activity of the muscles. Read this article to know more about this condition.

Written by

Dr. Afsha Mirza

Medically reviewed by

Dr. Abhishek Juneja

Published At October 27, 2023
Reviewed AtMay 9, 2024

Introduction:

Two states of tremor in dystonia are presently recognized:

1. Dystonic tremor, which is a tremor created by dystonic muscle contraction.

2. Tremor linked with dystonia, which is a tremor in a region of the body that is not dystonic, but there is dystonia somewhere else.

Both states of tremor in dystonia often correspond to essential tremor or another pure tremor syndrome (sole head and voice tremors and task-specific handwriting tremor), and connections among these tremor conditions have long been discussed. Misdiagnosis is likely as mild dystonia is often encountered in patients with tremors. Essential tremor is a syndrome, not a disease condition. The term primary tremor is used for any condition in which tremor is the only or main abnormality with no identifiable etiology other than possible hereditary inheritance. Tremor is so prevalent in primary dystonia that it is assumed to be an element of primary dystonia. Dystonic tremors are present at rest, in sustained poses, and voluntary movement, and they may also be focal and task-specific. These factors are identical to common and less common focal and precise task tremors.

What Is Dystonia?

Dystonic tremor is a movement disorder in which an individual's muscles contract uncontrollably. Contraction forces the active body region to turn involuntarily, resulting in redundant actions or strange postures. Dystonia can involve one muscle, a group of muscles, or the whole body. Dystonia impacts approximately one percent of the inhabitants, and females are more prone to it than males. Most dystonia patients do not have a specific causative factor. Dystonia appears to be connected to problems in the basal ganglia (a group of structures near the center of the brain). That is the region of the brain that is accountable for starting muscle contractions. Acquired dystonia is generated due to the impairment in the basal ganglia. The injury could be a consequence of the following:

  • Brain trauma.

  • Stroke (injury to the brain from interruption of its blood supply).

  • Tumor.

  • Lack of oxygen.

  • Infection.

  • Drug responses.

  • Lead or carbon monoxide poisoning.

Idiopathic (without a known cause) or primary dystonia is usually inherited from a parent. However, some carriers of the disease may never develop dystonia themselves. The manifestations may differ widely among members of the same household.

What Are the Manifestations of Dystonia?

Manifestations of dystonia can vary from very benign to severe. Dystonia can involve various body parts, and the manifestation of dystonia usually advances via stages. Some earlier manifestations are as follows:

  • Pulling leg.

  • Cramping of the foot.

  • Spontaneous pulling of the neck.

  • Uncontrollable blinking of eyes.

  • Speech problems.

Anxiety or exhaustion may bring on the signs or induce them to deteriorate. For example, individuals with dystonia usually complain of aches and tiredness because of continuous muscle contractions. If dystonia signs appear in pre-adolescence, they typically occur first in the foot or hand. But then they quickly advance to the entire body. After adolescence, though, the advancement rate manages to slow down. When dystonia occurs in early adulthood, it generally starts in the upper body with gradual advancement of symptoms. Dystonia that begins in early adulthood, stays focal or segmental (involves either one portion of the body or two adjoining parts).

What Are the Classifications of Dystonic Tremors?

  • Blepharospasm - It is a kind of dystonia that involves the eyes. It usually starts with uncontrolled blinking. At first, it involves just one eye, subsequently leading to the involvement of both eyes. The cramps cause the eyelids to shut involuntarily. The individual may have normal sight however this permanent closing of the eyelids makes the individual sightless.

  • Cervical Dystonia - It is also called torticollis and is the most typical style. Cervical dystonia commonly appears in middle-aged people but is noted in individuals of all ages. Cervical dystonia involves the neck muscles, forcing the head to turn, twist, or be drawn back or front.

  • Cranial Dystonia - It involves the head, face, and neck muscles.

  • Oromandibular Dystonia - It induces cramps of the jaw, lips, and tongue muscles. This dystonia can generate difficulties with speech and swallowing.

  • Spasmodic Dysphonia - Also called laryngeal dystonia involves the throat muscles that are responsible for speech. It is a rare form of tardive dystonia induced due to low-dose Risperidone, an antipsychotic medication.

  • Paroxysmal Dystonia - It is serialized. It occurs only during seizures (tremor episodes). For the rest of the time, the individual is normal.

  • Torsion Dystonia - It is a very rare condition. It involves the whole body and disables the individual. Symptoms occur in preadolescence. Investigators have discovered that a mutation in the gene DYT1 induces torsion dystonia.

  • A Writer's Twitch - It is a dystonia that only happens while writing, involving the hand and forearm muscles.

How to Treat Dystonic Tremors?

There are numerous options for treating dystonia. The doctor decides the treatment duration based on the type of dystonia. The most common therapy is botulinum toxin (BoNT). It infiltrates the muscle and obstructs the consequence of the chemical acetylcholine that stimulates muscle reactions. The injection is required to be taken every three months. For disability caused by dystonia, deep brain stimulation is an alternative available therapy with 80 percent to 90 percent improvement in the symptoms. In deep brain stimulation, an electrode is implanted into specific areas of the brain responsible for their movements and activities. It is then attached to a battery-powered stimulator embedded in the chest with extension wires connected to the leads. The electrode sends electrical pulses produced by the stimulator to the brain area to relieve muscular contractions. The stimulation is adjusted using a remote control by the doctor to reach the appropriate settings of frequency and power. Medicines help relieve the transmissions that induce muscles to contract unduly in dystonia. The drugs which are as follows:

  • Levodopa.

  • Diazepam.

  • Procyclidine hydrochloride.

  • Clonazepam.

  • Baclofen.

  • Lorazepam.

The sensory trick is another alternative. With a sensory trick, a stimulus is applied to the affected or adjacent body part, which may relieve the muscular contractions. By simply touching this site, individuals can manage their contractions. It may not always be effective in relieving the symptoms. Speech therapy, physical treatment, and stress control are also utilized to treat the signs of dystonic tremors.

Conclusion:

Further and in-depth study is required to gather data to help comprehend the numerous conditions and hereditary traits that generate preliminary tremors. A tremor in dystonia is a fairly commonly occurring disorder. However, what appears to be crucial is to understand whether it happens at the identical site as dystonia or anywhere else in the body; whether the occurrence is typically postural or kinetic or at rest. Clinicians must recognize it and isolate it from other standard reasons for tremors, such as essential tremors (rhythmic shaking) and Parkinson’s disease (disease of the central nervous system that involves movement, usually including tremors). There are different therapeutic modalities available to address the issue. Additional investigation is needed for adequate understanding and treatment, and that which is available and effective to all patients.

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Dr. Abhishek Juneja
Dr. Abhishek Juneja

Neurology

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