Dystonia in cerebral palsy causes twisting and repetitive involuntary muscle contractions that are often painful and interfere with regular movement, posture, sleep, and normal daily activities. Dystonic cerebral palsy is one of several types of CP and is a subcategory of dyskinetic cerebral palsy.

What Is Dystonia in Cerebral Palsy?

When the basal ganglia area of the brain is damaged, it may result in dystonia. This area of the brain is where nerve cells communicate and is responsible for voluntary muscle contractions. It’s not uncommon for people with cerebral palsy to have some damage to the basal ganglia area of the brain and therefore experience dystonia. This movement disorder causes a person’s muscles to contract involuntarily, often in a twisting, repetitive movement. It can also result in abnormal posture. Muscle contractions can affect one or many parts of the body and can range from mild to severe.

Dystonic Cerebral Palsy Complications

• Dystonia may result in malnutrition due to high energy expenditure.
• Abnormal postures and uncontrollable movements can be painful.
• Motor functions can be impeded due to the involuntary movements.
• Dystonic postures and hypertonia can make caregiving a challenge.
• Physical disabilities can interfere with daily activities or specific tasks.
• Sleep disruption and exhaustion are common due to continual movements.
• Dystonia can make positions for sitting or lying down difficult to achieve.
• Difficulties with vision, speech, or swallowing food and drink may arise.
• In some cases, depression, anxiety, and social withdrawal are present.

Related Conditions

Dyskinesia can sometimes be confused with dystonia. Dyskinesia is a broad term for involuntary muscle contractions and includes a wide range of movements. Although dystonia also causes involuntary muscle contractions, it is a specific type of dyskinesia classified as repetitive, twisting movements that usually affect the head and neck, vocal cords, eyelids, feet, or hands and is often on one side of the body.

Symptoms of Dystonia in Cerebral Palsy

Dystonia is unique to each person, so the symptoms often present differently from one individual to the next. This applies to the type of symptoms, the bodily location of the symptoms, and the severity of the symptoms.

Common symptoms include:

• Twisting and repetitive movements
• Rapid, slow, or painful movements
• Awkward postures

Over time, it’s possible for the symptoms to change from one area to multiple areas and for the symptoms to improve or get worse. The symptoms can change throughout the day, may only occur during a specific action, and often worsen with stress or fatigue. When dystonia appears in a child, it usually begins in a foot or hand then quickly progresses to the rest of the body. When dystonia appears in an adult, the progression rate tends to be much slower.

Types of Dystonia

There are many types of dystonia, and they are classified according to which body parts are affected by the symptoms. Some types of dystonia are:

• General dystonia: most or all of the body is affected
• Focal dystonia: only one specific body part is affected
• Segmented dystonia: adjacent body parts are affected
• Multifocal dystonia: more than one unrelated body part is affected
• Hemi dystonia: body parts on only one side of the body are affected
• Blepharospasm: uncontrollable blinking of the eyelids
• Cervical dystonia: affects the neck muscles causing the head to twist, turn or pull
• Cranial dystonia: affects the face, head, and neck muscles
• Oromandibular dystonia: affects the lips, tongue, and jaw muscles
• Spasmodic dystonia: affects the throat muscles responsible for speech
• Paroxysmal dystonia: symptoms only occur during attacks or episodes

Management of Dystonic Cerebral Palsy

There is currently no cure for dystonia. Your doctor may recommend medications, therapy, surgery, or a combination of these treatments. Common medications that may help improve symptoms are:

• Botox
• Carbidopa-levodopa
• Tetrabenazine or deuterobenzene
• Diazepam, clonazepam, or baclofen

Therapies that are frequently recommended to help control symptoms include:

• Physical therapy
• Occupational therapy
• Speech therapy
• Stretching or massage

Surgery is usually the last resort when other treatments don’t work or the symptoms are severe. Different types of surgeries include:

• Deep brain stimulation
• Focused ultrasound
• Selective denervation

Sensory Tricks

One well-known way to temporarily suppress unwanted dystonic movements is to use sensory tricks. For some people with dystonia, specific physical stimulation applied to certain body parts can dampen unwanted muscle contractions and prepare their bodies to make the desired movement. By simply touching this area, some people may be able to control their involuntary movements temporarily. Some examples of this trick include:

• Tucking a hand under the chin
• Resting the back of the head against a wall
• Touching the face with a finger
• Placing a hand behind the back

The Cerebral Palsy Family Lawyers at Janet, Janet & Suggs, LLC understand that CP can have a huge emotional and financial impact on children and their families. If you think it’s possible that your child’s or loved one’s cerebral palsy is the result of medical malpractice, contact us today and let us help you and your family evaluate your legal options and understand your rights in a legal case.

Reviewed by:
Claire Surles, RN
Registered Nurse

Claire comes to JJS after a 10-year career as a labor and delivery nurse. She dedicated her hospital efforts to advocating for families, providing the safest birthing environment possible as Newborn Admission Nurse at UMMC St. Joseph Medical Center in Towson, Maryland. Her passion for helping those who experienced losses at any stage of gestation led to her appointment as Coordinator of the hospital’s ROOTS perinatal loss program. READ FULL BIO

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