DYSTONIA

Réussis tes devoirs et examens dès maintenant avec Quizwiz!

Overflow dystonia

dystonic movement or postures extend beyond the commonly involved body region.

Botox injection

effective in improving postural deviation and pain in approximately 80% to 90% of people with cervical dystonias

2. Secondary Dystonia

env'tal causes (exposure to CO, cyanide, methanol and underlying causes like brain tumors, cp, PD, stroke, ms, CNS injuries, infections of the brain)

Clinical presentation of head deviation or neck pain

first diagnostic sign

Heredodegenerative (x-linked dystonia parkinsonism, HD, Wilson dse and PD)

geneteically inherited disorder marked by progressive decline in neurological structure and function

Focal

limited to one body segment (cervical dystonia, writer's cramp, and blepharospasm)

Mirror dystonia

mirror movements are observed in the opposite body side

Dystonic movements

movement is a twisting nature or a pull in a preferred direction, repetitive and patterned attitude (consistent and predictable)

3. Dystonia Plus (myoclonus dystonia and dopa-responsive dystonia)

non-degenerative neurochemical disorders associated with other neurologic conditions (examples)

Hemidystonia

one side of the body

• Average age of onset (primary) is 12 year old • Focal dystonias → 30-50 years

onset (dystonia & focal dystonia)

1. Primary Dystonia

r/o secondary causes

geste antagoniste

sensory trick

dyshagia

serious side effect of botox injection

• If secondary to CP →

static for several years

(light touch to the chin for people with cervical dystonia)

what to do to alleviate cervical dystonia

Observed at peak of dystonic movement. Determining that there is no evidence for other neurologic disorders, or secondary dystonia is essential in the diagnosis of idiopathic dystonia

when is overflow dystonia observed?

because hindi nagddevelop brain sa CP kaya di na rin masyado lumalala.

why is the prognosis static in CP?

Focal dystonias

writer's cramp

Multifocal

2 or more non contiguous body regions (right arm and left leg)

1. age of onset 2. body distribution of symptoms 3. temporal pattern 4. assoc features

4 subcategories accdng to characteristics

Segmental

Adjacent body parts (cranial dystonia → blepharospasm with jaw movement)

- early onset birth to 28 yrs and older than 28 yrs a. Infancy (birth to 2 years) b. Childhood ( 3-12 years) c. Adolescence (13-20 years) d. Early Adulthood (21-40 years) e. Late Adulthood (>40 years)

Age of Onset (ADS 2 categories:

Isolated | Combined with other movement disorders

Associated features

Best predictor of prognosis → age of onset

Best predictor of prognosis →

1. Focal 2. Segmental 3. Multifocal 4. Generalized 5. Hemidystonia

Body Distribution of Symptoms

- results in 3-7 days post injxn and - last for 3-4 months

Botox injection

1. Nervous System Pathology 2. Inherited or Acquired

CLASSIFICATIONS BY ETIOLOGY

1. Age of onset 2. Area of body affected 3. Underlying cause

Characteristics used to classify dystonia:

-Genetic testing for dystonia -Test to r/o other neurologic diseases -No definite test for dystonia • Clinical presentation of head deviation or neck pain → first diagnostic sign • Patients usually has normal perinatal and developmental history • EMG sustained simultaneous contractions of agonist and antagonists

DIAGNOSIS test: (3)

neuroleptics • Neuroleptic-induced dystonia (blepharospasm, torticollis, retrocollis

Drug induced etiology DYSTONIA

is often inherited and has poor prognosis

Dystonia that begins in the first year of life

typically patterned, twisting, and may be tremulous

Dystonic Movements: describe

1. Genetic-based dystonia → most common (2/3) i. DYT1 - typically starts in one extremity and progresses to other limbs. Cranial and cervical (rarely involved) ii. DYT6 - early involvement of cervical, oromandibular, laryngeal and speech 2. Focal dystonias → writer's cramp affected: Common among keyboard operators and musicians • Result of abnormal or repetitive biomechanics • May also occur as part of per nerve d/o • Evidence of genetic basis 3. Drug induced → neuroleptics • Neuroleptic-induced dystonia (blepharospasm, torticollis, retrocollis)

ETIOLOGIC AND RISK FACTORS

1. Dystonia posture 2. Dystonic movements 3. GESTE ANTOGINISTE (sensory trick) 4. Mirror dystonia 5. Overflow dystonia

FIVE FEATURES OF DYSTONIA THAT GUIDE DIAGNOSIS

1. Primary Dystonia 2. Secondary 3. Dystonia Plus 4. Heredodegenerative x-linked dystonia parkinsonism, HD, Wilson dse and PD

FOUR CLASSIFICATIONS BY CAUSE

cause: 1. evidence of genetic basis 2. abnormal or repetitive biomechanics 3. nerve d/o

Focal dystonias aka: affected: cause: (3)

• Emphasis on stress and pain management • Energy conservation • Adaptive equipment • Mobility • Selective splinting • Sensory retraining

IMPLICATIONS FOR THE PHYSICAL THERAPIST

• 250,000 in North America • 1.1 in every 100,000 • Male to female 1:1.6

INCIDENCE

Genetic-based dystonia → most common (2/3) i. DYT1 - typically starts in one extremity and progresses to other limbs. Cranial and cervical (rarely involved) ii. DYT6 - early involvement of cervical, oromandibular, laryngeal and speech

MC etiology of dystonia and explain

• Starts near birth and (+) family history → progressively worse • If secondary to CP → static for several years

PROGNOSIS (progressively worse)

• Botox injection → effective in improving postural deviation and pain in approximately 80% to 90% of people with cervical dystonias results in 3-7 days post injxn and last for 3-4 months | most serious side effect: dysphagia • Physical and Occupational Therapy • Surgery / DBS

TREATMENT

Static | progressive | variable | persistent | action specific | diurnal | paroxysmal

Temporal Pattern

1. Dystonia posture

a body part is flexed or twisted along its longitudinal axis and sensation of rigidity and traction is present

DYSTONIA

a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures, or both

Generalized

affects the trunk and at least two other body parts

Geste antagoniste (sensory trick)

alleviation of dystonia occurs during the geste movement.

Temporal Pattern

describes the dse course


Ensembles d'études connexes

Reproductive System and Breast Problems

View Set

The Basics of Social Research Chapters 6 and 7

View Set

CFE: Accounting concepts questions.

View Set

1-Guide to Computer Forensics and Investigations

View Set

HAP lecture exam; urinary system

View Set

Art Appreciation Ch. 12 (Gothic art)

View Set