STUDY - Technical - New Dacian's Medicine
Dystonia
(Classical / Allopathic Medicine)
Dystonia is marked
by slow, involuntary movements of large-muscle groups in the
limbs, trunk, and neck. This extrapyramidal sign may involve
flexion of the foot, hyperextension of the legs, extension,
and pronation of the arms, arching of the back, and extension
and rotation of the neck (spasmodic torticollis). It's
typically aggravated by walking and emotional stress and
relieved by sleep.
Dystonia may be
intermittent - lasting just a few minutes - or continuous and
painful. Occasionally, it causes permanent contractures,
resulting in a grotesque posture. Although dystonia may be
hereditary or idiopathic, it usually results from an
extrapyramidal disorder or from adverse drug effects.
HISTORY:
If possible, include the patient's family when obtaining his history. The family may be more aware of behavior changes than the patient.
Ask the patient when dystonia occurs. Is it aggravated by emotional upset? Does it disappear during sleep? Is there a family history of dystonia?
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Note especially the use of phenothiazines or antipsychotics. Dystonia is a common adverse effect of these drugs, and dosage adjustments may be needed to minimize this effect. Also, ask the patient about alcohol intake.
If possible, include the patient's family when obtaining his history. The family may be more aware of behavior changes than the patient.
Ask the patient when dystonia occurs. Is it aggravated by emotional upset? Does it disappear during sleep? Is there a family history of dystonia?
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Note especially the use of phenothiazines or antipsychotics. Dystonia is a common adverse effect of these drugs, and dosage adjustments may be needed to minimize this effect. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Check voluntary muscle movement by observing the patient's gait as he walks across the room. Have him squeeze your fingers to assess muscle strength. (See Recognizing dystonia.)
Check coordination by having the patient touch your fingertip and then his nose repeatedly.
Check gross-motor movement by placing the patient's heel on one knee, sliding it down his shin, and then returning it to his knee.
Assess fine motor movement by asking the patient to touch each finger to his thumb in succession.
Check voluntary muscle movement by observing the patient's gait as he walks across the room. Have him squeeze your fingers to assess muscle strength. (See Recognizing dystonia.)
Check coordination by having the patient touch your fingertip and then his nose repeatedly.
Check gross-motor movement by placing the patient's heel on one knee, sliding it down his shin, and then returning it to his knee.
Assess fine motor movement by asking the patient to touch each finger to his thumb in succession.
Recognizing
dystonia
Dystonia, chorea, and athetosis may occur simultaneously. To differentiate between them, keep the following points in mind:
Dystonic movements are slow and twisting and involve large muscle groups in the head, neck (as shown on the right), trunk, and limbs. They may be intermittent or continuous.
Choreiform movements are rapid, highly complex, and jerky.
Athetoid movements are slow, sinuous, and writhing but always continuous; they typically affect the hands and extremities.
SPECIAL CONSIDERATIONS:
If dystonia is severe, protect the patient from injury by raising and padding his bed rails. Provide an uncluttered environment if he's ambulatory.
Dystonia, chorea, and athetosis may occur simultaneously. To differentiate between them, keep the following points in mind:
Dystonic movements are slow and twisting and involve large muscle groups in the head, neck (as shown on the right), trunk, and limbs. They may be intermittent or continuous.
Choreiform movements are rapid, highly complex, and jerky.
Athetoid movements are slow, sinuous, and writhing but always continuous; they typically affect the hands and extremities.
SPECIAL CONSIDERATIONS:
If dystonia is severe, protect the patient from injury by raising and padding his bed rails. Provide an uncluttered environment if he's ambulatory.
PEDIATRIC
POINTERS:
Children don't exhibit dystonia until after they can walk; it rarely occurs until after age 10.
Common causes of dystonia in children include Fahr's syndrome, dystonia musculorum deformans, athetoid cerebral palsy, and the residual effects of anoxia at birth.
Children don't exhibit dystonia until after they can walk; it rarely occurs until after age 10.
Common causes of dystonia in children include Fahr's syndrome, dystonia musculorum deformans, athetoid cerebral palsy, and the residual effects of anoxia at birth.
PATIENT
COUNSELING:
Encourage the patient to obtain adequate sleep and avoid an emotional upset. Avoid range of motion exercises, which can aggravate dystonia.
Encourage the patient to obtain adequate sleep and avoid an emotional upset. Avoid range of motion exercises, which can aggravate dystonia.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)