Muscular dystonia – what it is and how to treat pathological muscle contraction
- 1 Kinds
- 2 Development mechanism
- 3 The reasons
- 4 Symptoms
- 5 Diagnostics
- 6 Treatment
- 7 Complications
- 8 Prevention
There is a disease in infants, older children, adults. The reasons lie in the pathological course of pregnancy, damage to the central nervous system, diseases of other organs, infections. The ICD10 code is G24.
Etiology, various manifestations of the disease allow us to talk about different types of muscular dystonia. Its course is influenced by the causes, the age at which the first signs appeared, the area of the lesion, and the characteristics of manifestation.
Genetic predisposition causes the occurrence of primary (idiopathic) dystonia. It is found already in infants. At least in the initial stages of the disease dystonia is not associated with damage to other organs.
Secondary dystonia occurs as a result of other diseases, intoxication, medication.
Age of first symptoms
This criterion allows you to select dystonia of several ages. The infant is found from the moment of birth to two years, the child – up to 12 years, teenage – up to 20. Young is diagnosed to 40 years. The last species is adult dystonia.
If abnormal muscle contraction is characteristic of only one part of the body, they speak of focal dystonia. The most common subspecies are torticollis and blepharospasm.
The defeat of several areas characterized by multifocal dystonia.
In case of violation of the tone of the muscles of the whole body or more of its part, they speak of a generalized form of pathology. It is characterized by strange postures, which in the normal state of a person is very difficult to maintain. Patients may unnaturally bend the spine and so lie.
A change in tone on one side of the body indicates hemidistonia.
If muscle disorders cover several adjacent parts of the body, they speak of segmental dystonia. In most cases, this pathology is characteristic of mature age, it is accompanied by head tremor.
Degree of stress
The most well-known classification of dystonia, with which every mother faced after the birth of a baby, is the allocation of high and low tone.
In the first case we are talking about hypertonus. It is characterized by too strong simultaneous tension of the flexor and extensor muscles. It is difficult to put on clothes for a child with hypertonus, it is difficult for him to play. Many poses cause pain, discomfort. Hence the frequent crying, anxiety.
At the same time, E. Komarovsky says that hypertonus is a normal phenomenon for an infant up to 3-4 months.
Less attention is usually given to hypotonus in children. It is characterized by muscle weakness. The kid, who has dystonia of this type, sleeps a lot, does not show anxiety. It seems that he is all right. However, this form of the disease is dangerous. It leads to a delay in physical development. Children with hypotoneus later begin to hold the head, sit, walk, cannot hold objects in their hands.
Some children have symptoms of both forms of dystonia at the same time. Moreover, excessive tension is usually characteristic of the lower limbs, and weakness of the muscle tissue is typical for the upper limbs.
Both forms occur in older age as a result of the development of neurological, mental, and infectious diseases.
Maintaining muscle tone, changing it, ensuring complex movements refers to the functions of the extrapyramidal system. It includes the subcortical nucleus, the cerebellum, the pathways of the medulla oblongata, the cortex. The process of contraction also involves the nerves innervating the skeletal muscles, as well as the muscle fibers themselves, whose complex structure provides movement.
Muscular tissue consists of elongated cells – myocytes, a sarcoplasmic reticulum rich in calcium, and myofibrils, which have the appearance of elongated filaments.
Muscle contraction occurs when it reaches the nerve impulse emanating from the brain. The nerve cell synthesizes the mediator acetylcholine and provokes the release of calcium from the sarcoplasmic reticulum. Calcium interacts with troponin protein. The latter is contained in the myofibrils and causes a convergence of actin filaments. As a result, the sarcoplasmic reticulum decreases, muscles contract.
Due to the dysfunction of the extrapyramidal system, the synthesis of acetylcholine and other mediators, which provide the connection between neurons, is disrupted. Incomplete impulse treatment leads to a one-time contraction of the antagonist and agonist muscles, although in normal situations they oppose each other.
This process underlies the development of convulsive phenomena, as well as the violation of tone.
Severity of manifestation
Sometimes dystonia occurs as an acute reaction to the use of certain psychotropic drugs. If the symptoms appear in a situation associated with a strong mental stress, talk about egodystonia. This type of pathology is a psychological disorder, is temporary.
Most often dystonia is a constant progressive nature.
Muscular dystonia in children and adults occurs due to various reasons. Common are genetic predisposition – it leads to the emergence of primary dystonia, not associated with any other diseases. An example of such a disease is Duchenne dystrophy.
In newborns, children under two years of age, development of muscular dystonia is associated with hypoxia, abnormal development, brain pathologies that occur during fetal development, and birth injuries. These are various diseases and habits of the future mother: hypertension, diabetes, smoking, alcoholism, drug taking, toxemia.
Another group of factors that cause muscular dystonia in infants is associated with impaired pregnancy and childbirth: placental abruption, high hydration or low water, entanglement by the umbilical cord, a long anhydrous period, rapid delivery, improper management of delivery.
Kids and teens
The main reason for the occurrence of dystonia in children over the age of two years is a disease of the nervous system, infectious diseases, the occurrence of neoplasms. Often spasm and tonus disorder occurs with encephalitis and meningitis.
Dystonia is one of the characteristics of cerebral palsy. Pathology occurs with injuries, intoxication.
The range of diseases that cause muscular dystonia in adults is quite wide and includes encephalitis, cerebral hemorrhage, Huntington’s disease, oncology, multiple sclerosis, Parkinson’s disease, Wilson-Konovalov disease. In the same way as in children, infectious diseases, injuries, poisonings lead to pathology.
Features manifestations of dystonia, manifested in increased or decreased muscle tone, are different. In this regard, it is customary to isolate the signs of hypertonus and hypotonia.
Symptoms of hypertonus
The tendency of most toddlers to hold their limbs slightly bent and divorced to the side attracts attention. Any attempt to straighten them encounters resistance. Infant-bodied babies often tilt the head back. Other symptoms include anxiety, crying, sleep disorders, trembling of the chin when crying. Such babies often burp when they eat or after eating.
As the child develops, involuntary spasms of the arms and legs become noticeable. Perhaps walking on the toes, leading to incorrect formation of the foot. With a high tone of the muscles of the body develops curvature of the spine.
In adolescents and adults there is a violation of handwriting, numbness or hardening of the muscles after prolonged exertion, the development of convulsive phenomena. Muscle aches appear.
Symptoms of hypotonia
Newborns with reduced tone sleep most of the time, eat little, are not interested in what is happening around them, do not want to move. They quickly begin to lag behind in development. Older children can not hold objects in their hands, pen.
In adults, pathology is characterized by general weakness, apathy, and inability to perform any actions.
Symptoms of asymmetric tone
In the presence of both high and low voltage, there is an attempt of the child to adopt an unusual posture, depending on the type of tone. Lying on his tummy, he will constantly strive to turn to the side with increased muscle tension. Arcuate bending of the whole body is possible.
When lying on the back of the child turns the head. Some curvature of the pelvis is noticeable.
An additional symptom is the bending of the limb on the one hand, the relaxed state on the other. In a small child, these manifestations are most noticeable.
Other signs indicate dystonia of the muscles. These are various involuntary movements, shouting of sounds, words, change of a timbre of a voice. Speech becomes blurred, incomprehensible. A person is not able to hold a certain position.
The combination of several symptoms allows to distinguish the following syndromes:
- Cervical dystonia. Differently pathology is called spastic torticollis. Appears due to the defeat of the muscle fibers responsible for the position of the head. It is possible to learn torticollis by a characteristic turn of the head.
- Cranial. Captures the muscles of the neck, head, face.
- Torsion. Genetically determined pathology is associated with the formation of postures that it is difficult or impossible for a healthy person to accept. Pathology leads to disability. Develops mainly in childhood.
- Writing spasm. The contraction occurs in the muscles of the hand while writing.
- Blepharospasm. Dystonia first manifests itself in uncontrollable bouts of frequent blinking, later leading to the inability to open the eyelids. In severe cases, blindness appears.
The development of the disease goes through several phases. At the first, the symptoms occur only after the person has experienced a strong nervous tension. In the quiet period they disappear. At this stage, there are convulsions in the legs, stiffness of movements, numbness after a long load. There is frequent blinking, nodding, chewing movements.
In the second stage, signs of dystonia are also observed during dormancy. Appear pain.
On the third, the changes are so strong that they are visible from the outside. They do not depend on the load. A pathological lesion of the skeleton occurs, the foot, neck, and spine are bent.
At the last stage, the motor abilities are very serious, depending on the area of the lesion, they do not allow the person to move independently or perform certain actions. If the disease develops in a child, it lags behind in development.
Identification of signs of muscular dystonia usually occurs at the doctor’s office. To clarify the diagnosis prescribed MRI, electroencephalography, ultrasound with Doppler, electroneurography.
Children spend neurosonography.
At the initial stage of development of muscular dystonia, drug treatment is not carried out. Physiotherapy, massage, exercise therapy is recommended. With the progression of the disease shows the use of drugs.
To improve the conductivity of the nerve impulse prescribed drugs to regulate the action and content of neurotransmitters. Benzotropin blocks acetylcholine, Lorezapem and Diazepam regulates GABA, Levodopa activates the production of dopamine.
Nootropic drugs are assigned to improve the metabolic process, for example, Cerebrolysin, Nootropil, Glycine.
Brain activity improves drops Semax. Calcium gluconate is used to replenish calcium deficiency.
In some cases, botulinum toxin injections are recommended. The substance blocks the transmission of nerve impulses to the muscle for several months.
In severe situations, conduct implantation of the electrodes in the brain. They block the transmission of pulses.
One of the effective methods of normalizing muscle tone and reducing spasms is massage. It is conducted by courses twice a year, however, some elements for children and adults can be performed at home.
Before you do a massage, you need to consult with a neurologist and orthopedist. He will recommend which elements are shown on which part of the body, specify the duration of the course, indicate the diagnosis. Masseur on the basis of this information will form the right set of exercises.
When hypertonia shows procedures aimed at relaxing the muscular tissue. Use strokes, rubbing open palm and fingers. In some cases, acupressure is indicated. It is contraindicated to clap and tap with the edge of the palm.
When hypotoneus conduct a more intense massage. Pinch the affected area, pound, squeeze. Such actions will help restore normal growth and muscle development.
Regardless of who carries out the massage and where, it is required to follow some rules. The procedure begins an hour after eating. Ambient temperature should not exceed 22 ° C. In order not to damage the delicate skin, use a special cream or oil.
Physiotherapy is carried out to relieve symptoms of muscular dystonia. Mud and relaxing baths, water treatments, electrophoresis are prescribed.
To reduce hypertonicity in infants at home it is recommended to make paraffin boots. Older children, adults conduct acupuncture courses.
Patients with dystonia must be prescribed physiotherapy exercises. Two or three times a year, classes are held with a physiotherapist, the rest of the time – independently at home.
Babies are shown to conduct classes on fitball. Patients of any age in the absence of contraindications appoint swimming.
Incorrectly chosen treatment, its absence in a child leads to a significant delay in physical development, skeletal curvature, constant pain.
To reduce the likelihood of muscular dystonia in a child, expectant mothers are shown a balanced diet, walking in the air, and conducting regular medical examinations.
After birth, the child is examined by all specialists in accordance with the schedule. Any symptoms of pathology should be discussed with your doctor. This also applies to older children, adults.
Muscular dystonia appears as the primary disease caused by genetic disorders, sometimes develops due to CNS pathology, infectious diseases. Manifested by involuntary contractions, increased, decreased or asymmetric tone.