Focal Dystonia

What is focal dystonia?

Focal dystonia is a neurological disorder. It causes involuntary muscle movements or contractions in one part of your body. You may have focal dystonia in your neck, eyes, jaw or vocal cords. Focal dystonia can also affect your wrists, hands or fingers.

Focal dystonia is one type of dystonia. Dystonia is a neurological condition that causes uncontrollable muscle spasms.

What is task-specific focal dystonia?

Task-specific focal dystonia is involuntary muscle contractions that interfere with a specific task. Some examples of task-specific focal dystonia include:

• Embouchure dystonia: Muscle spasms or cramps in your lips, jaw or tongue may affect musicians who play brass or woodwind instruments.
• Musician’s dystonia: Involuntary wrist or hand contractions often affect pianists, guitarists or violinists.
• Writer’s cramp: Uncontrollable spasms in your hand or wrist can affect writing.

Task-specific focal dystonia often affects people who have jobs or hobbies that require a lot of fine motor skills, like tennis players.

What is the difference between focal dystonia and carpal tunnel syndrome?

Focal dystonia and carpal tunnel syndrome can cause similar symptoms. But focal dystonia occurs because of problems with how your brain and nerves communicate. Carpal tunnel syndrome develops because of overuse or problems with your nerves.

What are “the yips”?

When task-specific focal dystonia affects athletes who play sports involving lots of hand or wrist movement, it’s known as “the yips.” The yips commonly affect athletes who play golf or baseball.

Who might get focal dystonia?

Focal dystonia is most common in adults ages 40 to 60. Women and people assigned female at birth develop focal dystonia about three times as often as men and people assigned male at birth do.

How common is focal dystonia?

Although dystonia is one of the most common types of movement disorders, focal dystonia is relatively rare. It affects about 3 in every 10,000 people in the United States.

What causes focal dystonia?

Focal dystonia is idiopathic, which means experts can’t point to one factor that causes it. But we do know that focal dystonia occurs when your nerves and brain don’t communicate as they should.

Sometimes, focal dystonia symptoms are connected to changes in an athlete’s, writer’s or musician’s habits, such as:

• Changing their technique after a nerve injury.
• Learning a new sport or instrument.
• Practicing, performing or competing more than usual.

Researchers haven’t proven a genetic link in focal dystonia. But about 1 in 10 people who develop focal dystonia have a family history of it.

What causes the yips?

Some people think golfers or baseball players get the yips because of performance anxiety. But the yips may also happen because of improper form or overuse.

People with certain health conditions are more likely to get the yips as well, including those with:

• Cerebral palsy.
• Multiple sclerosis.

What are the symptoms of focal dystonia?

Focal dystonia symptoms can vary depending on what body part the dystonia affects. In general, the first sign of focal dystonia may be a slight decrease in muscle coordination. For example, you may drop items more easily if symptoms affect your hands. You may have difficulty eating or drinking without spilling if symptoms affect your mouth.

Over time, focal dystonia causes more severe muscle symptoms, including:

• Cramps.
• Muscle pain.
• Twitches (myoclonus).
• Abnormal postures of the affected body part.

People with focal dystonia may also deal with secondary symptoms. Secondary symptoms develop because of the emotional and physical stress of having the condition. They aren’t related to the muscles themselves. These symptoms might include:

• Blurred vision.
• Depression.
• Difficulty sleeping.
• Fatigue.
• Mood swings.
• Short temper.
• Trouble focusing.

Focal dystonia symptoms may worsen for a period, stabilize and then recur (come back). But in some people, focal dystonia may stop progressing altogether.

How is focal dystonia diagnosed?

To diagnose focal dystonia, your healthcare provider asks about your symptoms and medical history. They also examine the affected body part.

During diagnosis, your healthcare provider will rule out other conditions that could cause similar symptoms, such as overuse injuries. You may have a/an:

• Blood test to check for infections or other disorders.
• CT scan or MRI to look for tumors or other irregular growths in your brain or near the affected body part.
• Electromyogram to test how your muscles process electrical signals.

How is focal dystonia treated?

There isn’t a cure for focal dystonia. But treatment can reduce spasms and stop them from worsening. Focal dystonia treatment may include:

• Lifestyle changes: Changing a task’s physical sensations can help your brain process movements with less interruption. For example, a violinist may have fewer spasms if they wear a glove while performing. A writer’s symptoms may improve if they change the grip of the pen. You can also practice stretches or exercises to manage discomfort.
• Medications: Anticholinergics, such as trihexyphenidyl (Artane®) can help block the nerve signals that cause muscle spasms. Vesicular monoamine transporter 2 (VMAT2) inhibitors such as tetrabenazine (Xenazine®) can be used to change your brain chemicals that affect your nerves and muscles. In some cases, carbidopa/levodopa (Sinemet) may alleviate symptoms. Muscle relaxants (Baclofen) or benzodiazepines (clonazepam) may also be used.
• Injections: Botulinum toxin (Botox®) injections are a common dystonia treatment. Healthcare providers inject botulinum toxin directly into the affected muscle. The injection interferes with your brain signals that cause spasms. Most people who get injections need them every three months.
• Surgery: Rarely, your healthcare provider may recommend surgery. You may have a procedure to place electrodes in your brain (deep brain stimulation). These tiny devices control the signals that cause muscle contractions. You may also have a procedure to release the nerves that cause muscle spasms (selective denervation surgery).

How can I prevent focal dystonia?

Because experts don’t know what causes focal dystonia, there’s no guaranteed way to prevent it. But we do know that some factors can worsen focal dystonia. It may help to:

• Avoid excessive movements or talking.
• Manage stress with healthy coping techniques.
• Reduce fatigue with healthy sleep habits, exercise and a nutritious diet.

What is the outlook for focal dystonia?

Focal dystonia can spread and affect other parts of your body. In about 1 in 6 people with the condition, the focal dystonia spreads to other areas.

The good news is that treatment can reduce how frequent and severe focal dystonia symptoms are. If your symptoms don’t improve after treatment, speak with your healthcare provider. You may need to change the treatment approach.

What else should I ask my healthcare provider?

You may want to ask your healthcare provider:

• What’s the most likely cause of symptoms?
• What tests do I need to diagnose focal dystonia?
• What can I do to manage focal dystonia symptoms?
• What are my treatment options?
• What could happen if I don’t get focal dystonia treatment?

A note from Cleveland Clinic

Focal dystonia is a neurological condition that causes involuntary muscle contractions in one body part. Focal dystonia that affects your hand, wrist or arm is common in people who frequently use fine motor skills. It often affects musicians, athletes, hairstylists and writers. Focal dystonia can have similar symptoms to nerve injuries. But focal dystonia happens because of miscommunication among your nerves, muscles and brain. Treatment may include lifestyle changes, medications, injections or surgery.