Acquired Dystonia/Secondary Dystonia

Acquired Dystonia/Secondary Dystonia

Acquired dystonia (formerly known as secondary dystonia) result from apparent outside factors and are usually attributed to a specific cause, such as exposure to certain medications, trauma, toxins, infections, or stroke.

Acquired dystonia is defined as a dystonic disorder that develops mainly as the result of environmental factors that provide insult to the brain. Spinal cord injury, head, and peripheral injury are also recognised contributors to dystonia. Other examples of acquired dystonia  include levodopa-induced dystonia in the treatment of parkinsonism; acute and tardive dystonia due to dopamine receptor blocking agents; and dystonias associated with cerebral palsy, cerebral hypoxia, cerebrovascular disease, cerebral infections and post infectious states, stroke, encephalitis, brain tumor, and toxicants such as manganese, cyanide, and 3-nitroproprionic acid.

Acquired  dystonia is associated with approximately 50 neurological and metabolic diseases. Many of these diseases are genetic. This category includes diseases such as corticobasal degeneration, pantothenate kinase deficiency (aka Hallorvorden-Spatz), Huntington’s disease, Wilson’s disease, Leighs disease and juvenile parkinsonism.

Acquired dystonia  often presents  with a mixture of other neurological features, such as parkinsonian features like slowness of movement  (bradykinesia) and rigidity.

Causes

It is well established that dystonia is brought about by secondary causes such as drug exposure, head and peripheral trauma and other disorders. Studies also suggest that insults such as trauma may trigger or exacerbate symptoms in people who have a genetic predisposition to dystonia. Research continues to better understand these various manifestations of dystonia.

Diagnosis

Many of the ascribed causes of secondary dystonias are based on historical information or subtle clinical findings and have no diagnostic, radiologic serologic, or other pathologic marker.

Treatment

Treatment for acquired dystonia is attributed to additional neurological or metabolic disorders is usually directed by the specific requirements of that disorder.

Medications

Oral medications are often the main stay of treatment for secondary dystonia. Although there is no single drug that helps an overwhelming number of people, there are several that may be of benefit. These oral medications include levodopa, trihexyphenidyl, clonazepam, and baclofen (oral and intrathecal especially for dystonia and spasticity). Medications may be taken in combination.

Botulinum Toxin Injections 

Botulinum toxin injections may be used to treat specific body parts that may be affected, such as neck, jaw hands, or feet.

Surgery

Several surgical techniques may be appropriate for select individuals who do not respond to medications and botulinum toxin injections. These may include ablative surgeries such as pallidotomy and thalamotomy,  intrathecal baclofen, and deep brain stimulation. The specific characteristics of the disease or condition that is causing the dystonia may preclude an individual from select surgical procedures for dystonia, or present alternative surgical options.

Complementary Therapy

Complementary therapies may be explored, particularly physiotherapy, aquatic therapy, and regular relaxation practices.

Many people are experiencing similar symptoms. You are not alone in coping with dystonia. Reassurance from family, friends, and others who have dystonia is beneficial. Sharing experiences of support at support group meetings offers encouragement, camaraderie, and the latest information about new treatments and medical advances.