Disblance Muscles


This movement disorder can affect a select part of the body or entire body. The treatment ranges from medical management to deep brain stimulation surgery…..

Treatment for Dystonia

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.

Child Patient
Neurological Surgery 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.