Dystonia is a movement disorder that can affect a selected part of the body or entire body. The Dystonia treatment ranges from medical management to deep brain stimulation surgery…..
At Jaslok Hospital, we are recognized as the best dystonia treatment center in Mumbai. Dystonia is a neurological disorder characterized by involuntary muscle contractions that cause repetitive or twisting movements. It can affect various body parts, leading to pain and disability. Our dedicated team of specialists, state-of-the-art facilities, and innovative treatment approaches make us the go-to destination for patients seeking relief from Dystonia.
Dystonia is a multidimensional disorder that manifests itself in a variety of forms, each with its own set of symptoms and underlying causes. Despite intensive research, the actual cause of Dystonia remains unclear; however, it is largely assumed to be related to aberrant brain functioning, affecting normal signal exchange between the brain and muscles. As a result, people with Dystonia experience involuntary muscle contractions and adopt aberrant postures, adding to the condition’s complexity and problems. Ongoing research and medical investigation efforts aim to increase our understanding of Dystonia, opening the path for better diagnosis and therapy.
Dystonia is classified as primary or idiopathic (no known organic lesion) secondary when some known insult happened to the basal ganglia (drugs, trauma, toxins, neoplasm, infarction or other organic causes), or classified by the body region involved. Generalized dystonia (or idiopathic torsion dystonia) affects a wide range of body areas. It usually occurs in childhood (especially in early teen years) and often affects the limbs and feet.
Dystonia may be classified as primary, arising without an identifiable cause, or secondary, emerging due to other medical conditions or external factors. Some prevalent factors leading to secondary Dystonia include:
Symptoms of Dystonia manifest diversely, their intensity contingent on the type and severity of the condition. Noteworthy indications include:
An accurate diagnosis of Dystonia demands an exhaustive assessment by a best team of dystonia doctors in Mumbai. We are equipped with the state-of-the-art diagnostic techniques, ensuring precise identification of Dystonia and its root causes. The diagnostic journey may entail:
Dystonia is treated with a variety of medications designed to reduce muscle spasms. In a few cases, specific surgery may be needed. Our approach to Dystonia treatment revolves around personalized care, meticulously tailored to address the unique needs and symptoms of each patient.
Surgery may be considered when patients are no longer receptive to other treatments. It is most effective in patients who are suffering from Idiopathic Primary Generalized Dystonia Spasmodic Torticollis and Writer’s Dystonia . Surgery is undertaken to interrupt at various levels of the nervous system, the pathways responsible for the abnormal movements for e.g. dorsal root rhizotomies for patients suffering from Spasmodic Torticollis. Some operations intentionally damage small regions of the thalamus (Thalamotomy) , globuspallidus (Pallidotomy) or other deep centres in the brain. Deep brain stimulation is one of the most promising treatment. Other surgical approaches include cutting nerves going to the nerve roots deep in the neck close to the spinal cord (anterior cervical rhizotomy) or removing the nerves at the point they enter the contracting muscles (selective peripheral denervation).
In patients with Unilateral dystonia, Pallidotomy or Pallidal Stimulation it can be performed. However, in patients with bilateral generalised dystonia with truncal involvement and deep brain stimulation of the globus palliduminternus is the surgery of choice. The results of deep brain stimulation for dystonia are not apparent in the immediate post-operative period. It takes few months for the benefit of this surgery to be realized after careful programming and drug adjustments.
However the advantage of deep brain stimulation surgery over lesional surgery is that the titration of the surgery has a definite role in the treatment of spasmodic torticollis. Surgery is aimed at selectively denervating the muscles which are under tonic contraction. This selective denervation is done by exposing the dorsal nerve roots just outside the spinal canal from C1 to C6. With the help of electro-myographic studies and electrical stimulation during surgery the incriminated muscles are selectively denervated. The denervation is extended to avulsion of the nerves of the involved muscles, to prevent any recurrence. In one of the large series reported in literature it has been found that the results were good to excellent in nearly 88% of the patients out of 460 cases.
Jaslok Hospital stands unrivaled, with an esteemed reputation as the trusted center for Dystonia in Mumbai and India. It has the largest series of dystonia surgeries performed in the country. Our unwavering commitment to patient care, pioneering treatments, and successful outcomes have set us apart. With an amalgamation of expertise and compassion, our team ensures each patient receives unparalleled attention and care.
Our commitment to excellence, and continuous research have earned us a reputation as the leading dystonia clinic in Mumbai, India. The clinic highly focus on the right selection of the patients and ensuring that they get the best possible treatment. Besides the costs of the surgery are very competitive and only a fraction of what it would cost to get at the best centers of the world. We prioritize patient well-being and strive to make a meaningful difference in their lives.
Our team comprises world-class neurologists and specialists with extensive experience in diagnosing and treating dystonia. The team is led by the best neurologist in India, Dr. Paresh K Doshi. With their expertise and compassionate approach, our patients receive the best care possible.
Primary Generalized Dystonia is also known as Dystonia Musculorum Deformance (DMD). Most cases commence in childhood (age 0 to 13 years), though in some it may not appear till the teen years (age 13 to 20 years); adult onset is rare. Primary dystonia typically begins as a focal disturbance that progress either inexorably until it involves both sides of the body and leads to the patient’s death from respiratory difficulties as a result of truncal involvement or upto a point after which it becomes static. It is our observation that younger the age of onset, longer and more extensive the progress and vice versa, a conclusion also reached by other workers.
The various motor abnormalities in primary dystonia consist of phasic and/or tonic elements. Depending on sharing of irregular activities, primary dystonia may be defined as hemi-dystonic, generalized, focal or segmental and multi-focal primary dystonia, which affects two or more disjunct body sides, also occurs. The common treatment for dystonia contains of drugs like Trihexphenidyl Hydrochloride, Levodopa and Tetrabenzine. The role of surgery in dystonia is limited to patients who have failed to respond after certain time of medical treatment. Proper case selection is very important in achieving good surgical outcome. Patients who have primary dystonia or familial dystonia secondary to genetic abnormalities such as DYT-1 gene abnormality are the candidates most suitable for functional neurosurgical procedures.
Secondary dystonia occurs due to variety of causes including trauma, metabolic dysfunction, brain iron deposition (PKAN), infection, drug induced (tardive dyskinesias) etc. In several cases the cause may not be even known. Secondary dystonia are more resistant to treatment and may be more disabling. The diagnosis is established by a careful history and various investigations appropriate to each individual capacity.
Common focal Dystonia’s are as Follow:
Dystonia is treated by a variety of medications designed to reduce muscle spasms. In a few cases, specific surgery may be needed. Focal dystonia’s can be treated with Botulinum Toxin Type A. Botulinum toxin is produced by a bacterium called Clostridium botulinum, which is the bacteria that cause botulism. Botulinum toxin is injected in extremely small amounts directly into affected muscles to “weaken” the muscle or to actually “block” nerve signals telling the muscle to contract. The Botulinum toxin has a relatively short life span (from weeks to several months) as new nerve endings grow, at this stage the injections have to be repeated. It sometimes takes anywhere from 5-10 days for Botulinum toxin to begin affecting the muscles. Treatment for dystonia is designed to help lessen the symptoms of spasms, pain and disturbed postures and functions. Most therapies are symptomatic, attempting to cover up or release the dystonic spasms. No single strategy will be appropriate for every case. The approach for treatment of dystonia may be three tiered: oral medications, botulinum toxin injections and surgery. These therapies may be used alone or in combination.
Surgery may be considered when patients are no longer receptive to other treatments. It is most effective in patients who are suffering from Idiopathic Primary Generalized Dystonia Spasmodic Torticollis and Writer’s Dystonia . Surgery is undertaken to interrupt at various levels of the nervous system, the pathways responsible for the abnormal movements for e.g. dorsal root rhizotomies for patients suffering from Spasmodic Torticollis. Some operations intentionally damage small regions of the thalamus (Thalamotomy) , globuspallidus (Pallidotomy) or other deep centres in the brain. Deep brain stimulation is one of the most promising treatment. Other surgical approaches include cutting nerves going to the nerve roots deep in the neck close to the spinal cord (anterior cervical rhizotomy) or removing the nerves at the point they enter the contracting muscles (selective peripheral denervation).
In patients with Unilateral dystonia, Pallidotomy or Pallidal Stimulation it can be performed. However, in patients with bilateral generalised dystonia with truncal involvement and deep brain stimulation of the globus palliduminternus is the surgery of choice. The results of deep brain stimulation for dystonia are not apparent in the immediate post-operative period. It takes few months for the benefit of this surgery to be realized after careful programming and drug adjustments. However the advantage of deep brain stimulation surgery over lesional surgery is that the titration of the surgery has a definite role in the treatment of spasmodic torticollis. Surgery is aimed at selectively denervating the muscles which are under tonic contraction. This selective denervation is done by exposing the dorsal nerve roots just outside the spinal canal from C1 to C6. With the help of electro-myographic studies and electrical stimulation during surgery the incriminated muscles are selectively denervated. The denervation is extended to avulsion of the nerves of the involved muscles, to prevent any recurrence. In one of the large series reported in literature it has been found that the results were good to excellent in nearly 88% of the patients out of 460 cases.
