Combating Dystonia and Cramping Muscles
If you regularly experience muscle spasms resulting in you adopting abnormal postures, you may have a syndrome called dystonia.
With dystonia, muscles contract as incorrect signals are sent from the brain. Contractions make muscles stiffer, causing discomfort and pain. Muscle contractions can also turn into spasms, which can disturb posture in the affected region.
While there is still no consensus behind why dystonia may develop, it is thought to arise from an imbalance in the chemicals originating from the basal ganglia, a part of the brain that sends messages to the body to contract muscles. When dystonia arises from underlying conditions such as Parkinson’s, stroke, or encephalitis, it is called secondary dystonia.
Types of Parkinson’s-related Dystonia
‘Off’ dystonia: This form of dystonia is seen in people with Parkinson’s as their levodopa medication is wearing off, such as waking in the morning. As it is most likely to affect the
feet and legs, people who experience ‘off’ dystonia may find it challenging to get out of bed.
‘On’ dystonia: This occurs when dopamine levels in the brain are high during the peak-dose phase.
Some people with early-onset Parkinson’s are prone to dystonia. Compared to levodopa-based dystonia, spasms usually last for shorter periods but can happen randomly at any time of the day.
Dystonia with Parkinson’s
In Parkinson’s, dystonia typically affects the body’s region that is most affected by the condition. Dystonia can target either a single muscle or an entire group. Spasms in the calf and foot muscles are common. The toes may curl or turn up. In some cases, the feet turn in at the ankle. In the neck region, dystonia can cause your head to pull towards a particular side or even bend forward or backward. This can lead to your head, shoulders, and neck adopting unusual postures.
Concentrated movements often trigger dystonia in the hands. Dystonia can affect your eyelids by making muscles contract and causing excessive blinking or blepharospasm. Spasms in your vocal muscles can affect voice quality, pitch, and volume, which may require professional assistance from a speech-language therapist.
Oromandibular dystonia can affect the jaw, tongue, or the face, resulting in people opening or shutting their mouths abnormally, having unusual tongue movements, or even a grimacing facial expression.
Treating Dystonia
There are treatment options available, and the majority of people can be helped. Often several strategies need to be employed:
1. Identifying the problem
For people with Parkinson’s, the first thing to determine is the source of the Dystonia - is it arising from your levodopa medication or from Parkinson's itself? Have a carer maintain a diary of when the medicine is ingested, along with the time when dystonia episodes occur. This information can usually help determine if patterns are pointing towards the use of drugs. Taking a home video (e.g., with a smartphone) can help clarify whether there is dystonia.
2. Adjusting Medication
The first thing to determine is the trigger for the dystonia - is it arising from the levodopa medication or your Parkinson’s diagnosis itself? Maintaining a diary of when the medicine is taken, along with the time when dystonia episodes occur, can help you and your treatment team determine the cause.
Dystonia can often be treated by altering the timing and/or dose of medication. Before modifying your medication regimen, however, please discuss it with your GP or treating team.
You may be advised to try the following for ‘off-period’ dystonia:
- Taking a controlled-release levodopa dose at night, ensuring that benefits have not worn off by the morning.
- Taking a long-acting Dopamine agonist at night.
- Using short-acting dissolvable medication during the day for rapid relief of painful dystonia, although it may wear off quicker as well.
If you regularly experience ‘on-period’ dystonia from overstimulation of dopamine, options include:
- Using a drug that prolongs the effect of levodopa and smoothes out the peaks.
- Taking smaller doses at more frequent intervals.
3. Medication to treat Dystonia
If altering your Parkinson’s medication schedule does not seem to do the trick, then you may be given muscle relaxants, such as Diazepam, Clonazepam, or Baclofen, or anticholinergic drugs, such as Procyclidine (Kemadrin) and Trihexyphenidyl (Artane). Before modifying your medication regimen, please discuss it with your GP or treatment team first.
4. Botox
Botulinum toxin or botox, as it is more commonly known, can be injected into the muscles to block incorrect signals from the brain that are causing dystonia. Injections may need to be repeated once every quarter.
5. Sensory Tricks
Some people that experience dystonia make use of sensory cues and tricks to attain short-term relief. Touching the affected region or even a part near the affected area is seen to provide some relief, along with stretching. One explanation for this might be that unusual actions could be interrupting the irregular brain signals that cause dystonia.
6. Mindfulness and Relaxation
Relaxing activities such as a massage, warm bath, or meditation and exercise such as yoga may reduce muscle spasms.
7. Surgery
This is a highly specialised area. Deep Brain Stimulation or DBS involves placing electrodes into specific parts of the brain and stimulating those areas with electrical currents. It can be effective in treating disabling dystonia when medical management has failed. It is only appropriate for a minority of patients.
Selective peripheral denervation is another procedure where an incision in the neck allows surgeons to sever nerves connected to neck muscles that regularly spasm. Once again, this is rarely used.
8. Exercising for Cramps
Try modifying your exercise routine to accommodate more stretching-based and seated exercises. Stretching regimens prescribed by some physiotherapists could help reduce soreness in your muscle fibres.
Source: Parkinson’s UK, “Muscle cramps and dystonia”
Brain Foundation Australia “Dystonia”
European Brain Council “Dystonia Factsheet”