Focal Dystonia

Focal dystonia is an uncommon neurologic condition that causes involuntary muscle contractions. This is when your muscles tighten or move without you controlling them. It involves one specific part of your body.

It may occur in your neck, eyelids, jaw or vocal cords. It can also target your hands, fingers, wrists or feet and sometimes other parts of your body.

Treatment options are available and vary based on the type you have.

Types of focal dystonia

The types vary based on what part of your body they target:

• Blepharospasm: Your eyelids and brows
• Foot dystonia: Your foot and toes
• Hand dystonia: Your hand and fingers
• Neck dystonia (cervical dystonia): Your neck and sometimes your shoulders
• Oromandibular dystonia: Your face, jaw and tongue
• Spasmodic dystonia (laryngeal dystonia): Your vocal cords and voice box

What is task-specific focal dystonia?

Task-specific focal dystonia causes involuntary muscle contractions that interfere with activity. In this type, muscle tightness or movements only happen during a specific task.

Examples include:

• Embouchure dystonia: Muscle spasms in your lips, jaw or tongue affect musicians who play brass or woodwind instruments.
• Musician’s dystonia: Involuntary hand or wrist contractions affect pianists, guitarists or violinists.
• Writer’s cramp: Hand or wrist spasms make writing difficult.
• Runner’s dystonia: This dystonia only occurs when running or jogging.

This type often affects people whose jobs or hobbies require precise, repeated hand or facial movements.

What are “the yips?”

“The yips” is a term athletes use when task-specific focal dystonia affects their performance. It causes sudden, involuntary muscle movements during certain sports skills, especially those that require precise hand or wrist control.

The yips most often affect athletes who play golf or baseball, but they can happen in other activities that involve repeated, fine-motor movements.

Symptoms of focal dystonia

Symptoms depend on which body part it affects. Early on, you may notice small changes in coordination. For example, you might drop objects more often if it happens in your hands. If it affects your mouth, you may spill food or drinks more easily.

Over time, muscle symptoms can become more noticeable, including:

• Muscle cramps
• Muscle pain
• Muscle jerks
• Holding the affected body part in an unusual pose or position (abnormal postures)

Symptoms may worsen for a time, then stabilize. In some cases, they can spread to nearby areas.

What causes focal dystonia?

In most cases, there’s no known cause. When a condition has no clear cause, experts call it idiopathic.

Researchers believe it happens when your brain and nerves don’t communicate as expected. This signal mix-up can cause your muscles to tighten or move when they shouldn’t.

Sometimes, symptoms start after changes in habits or intense practice. For example:

• Changing technique after an injury
• Learning a new sport or musical instrument
• Practicing or performing more than usual

Because experts don’t know exactly what causes focal dystonia, there’s no guaranteed way to prevent it.

What causes the yips?

Experts don’t believe the yips have one single cause. Research suggests several factors may play a role, including:

• Repetitive fine motor movements: Athletes who repeat the same precise movement for many years, like putting in golf, may develop changes in how their brain and muscles communicate.
• Muscle or joint problems: Injuries or ongoing musculoskeletal problems may increase your risk. Pain or physical changes may affect how your nervous system controls movement.
• Changes in motor control: Some researchers think the yips may happen from overusing certain muscles and from muscles tightening or moving in unusual ways.
• Anxiety: Anxiety can make symptoms worse, but research shows that brain and nerve changes may also play a role.

Risk factors

Certain factors may increase the risk of developing focal dystonia, including:

• Age: Some types begin more often in childhood, and others in adulthood.
• Genetics: In rare cases, dystonia can run in families.
• Sex: Females are more likely than males to develop certain types.
• Underlying conditions: This can vary by type. For example, if you have a history of eye diseases, you may have a higher risk of developing blepharospasm.

Complications

Living with focal dystonia might feel stressful, and that stress may affect your overall health. Possible complications include:

• Depression
• Trouble sleeping
• Fatigue
• Mood changes or irritability
• Trouble concentrating

If these symptoms affect your job, hobbies or daily activities, talk with your provider. Support and treatment may help.

How doctors diagnose focal dystonia

This is a clinical diagnosis. This means that your healthcare provider will ask about your symptoms and medical history. They’ll also examine your affected body part with a physical and neurological exam.

There isn’t one single test that confirms it. Your provider might recommend:

• Blood tests to check for infections or other medical conditions
• CT scan or MRI to look for changes in your brain or near the affected area
• Electromyogram (EMG) to measure muscle electrical activity

Your provider makes the diagnosis based on your symptoms and exam findings. They’ll rule out other conditions that can cause similar symptoms, like overuse injuries.

Focal dystonia treatment

There isn’t a cure for focal dystonia, but treatment may help reduce symptoms and improve your ability to function. Your provider may recommend:

• Botulinum toxin injections (Botox®): This is the most effective treatment for dystonia. It works by relaxing overactive muscles and reducing abnormal movements and pain. Effects are temporary, so you’ll need repeat injections approximately every three months.
• Medications: Drugs like anticholinergics (tetrabenazine), benzodiazepines (clonazepam) and muscle relaxants (baclofen) may help with symptoms.
• Therapy: Physical or occupational therapy helps exercise and retrain muscles. Sensorimotor retraining or handwriting retraining may help with task-specific dystonia, like writer’s cramp. Biofeedback could also teach you how to better control muscle activity.
• Surgery: For severe cases, deep brain stimulation is when a surgeon places a small device in your brain to help control abnormal signals. Less common procedures that destroy malfunctioning areas of your brain (pallidotomy or thalamotomy) may be considered.

Treatment depends on the type and severity. Sometimes, providers combine treatments to increase effectiveness.

When should I see my healthcare provider?

You should see a provider if you notice ongoing muscle contractions, twisting movements or abnormal postures that you can’t control. If these movements affect your daily activities, like opening your eyes, writing or speaking, it’s important to get evaluated.

Seek urgent medical care if you develop sudden new neurologic symptoms along with dystonia, like new muscle weakness, a severe headache or confusion.

What is the prognosis for focal dystonia?

Focal dystonia is usually a long-term condition. Symptoms often continue over time, especially without treatment. Muscle spasms or abnormal movements may affect daily tasks, like writing, typing, speaking or keeping your eyes open. It could also interfere with your work, hobbies and favorite activities.

You might find relief with treatment. Some people notice strong improvement. Others see only partial relief. A small number of people may notice that treatment becomes less effective over time. In those cases, providers may adjust your care plan or consider other options.