Functional vs. Primary Dystonia: Understanding the Differences and How the DRP Can Help

 

What Is Primary (Idiopathic) Dystonia?

Primary dystonia is a neurological movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive movements, postures, or both. Dystonic movements are typically patterned, twisting, and may be tremulous. Dystonia is often initiated or worsened by voluntary action and associated with overflow muscle activation. Source: Dystonia Europe​

This form of dystonia is most commonly observed in adults over the age of 40 and is not typically degenerative. Focal dystonias, such as cervical dystonia (affecting the neck), leg dystonia, oromandibular dystonia, and task-specific dystonias like writer’s cramp, are prevalent in this age group. While the exact cause is often unknown, primary dystonia is thought to involve dysfunction in brain regions responsible for motor control, including the basal ganglia, cerebellum, and cortex. Source: PMC​

What Is Functional Dystonia?

Functional dystonia, also known as functional neurological symptom disorder, presents with similar symptoms to primary dystonia, such as abnormal postures and involuntary movements. However, it arises from a different mechanism. In functional dystonia, there is abnormal, unintended movement or positioning of the body due to the nervous system not working properly. The onset of symptoms is often preceded by an injury, illness, or emotionally stressful event. Source: Dystonia Medical Research Foundation​

Unlike primary dystonia, functional dystonia is not associated with structural brain abnormalities or neurodegeneration. Instead, it is considered a disorder of brain function, where the brain’s ability to control movement is disrupted, leading to involuntary muscle contractions. Functional dystonia can cause movement symptoms in various parts of the body, including the face, neck, shoulder, torso, and limbs. Source: Dystonia Medical Research Foundation​

Diagnosing the Differences

Differentiating between primary and functional dystonia involves a thorough clinical assessment. Key factors include the onset and pattern of symptoms, response to distraction, and the presence of specific clinical signs. Functional dystonia often presents with sudden onset, variability in symptoms, and may improve with distraction or certain maneuvers. In contrast, primary dystonia typically has a gradual onset and consistent symptom pattern.​

Diagnostic tools may include neurological examinations, imaging studies, and electrophysiological tests to rule out other conditions and support the diagnosis. It’s important to note that both forms of dystonia are genuine medical conditions requiring appropriate management.​

Treatment Approaches

Primary Dystonia

Treatment options for primary dystonia focus on managing symptoms and improving quality of life. These may include:​

• Botulinum toxin injections: Effective for focal dystonias, helping to reduce muscle overactivity.​

• Oral medications: Such as anticholinergics, benzodiazepines, or muscle relaxants to alleviate symptoms.​

• Deep Brain Stimulation (DBS): Considered for severe cases unresponsive to other treatments.​

• Physical and occupational therapy: To improve motor function and reduce discomfort.​

Functional Dystonia

Management of functional dystonia involves a multidisciplinary approach, addressing both physical and psychological aspects:​

• Education and reassurance: Helping patients understand the condition and its mechanisms.​

• Physical therapy: Focusing on retraining normal movement patterns.​

• Cognitive-behavioral therapy (CBT): To address underlying psychological factors and improve coping strategies.​

• Occupational therapy: Assisting with adaptations to daily activities.​

The Role of the Dystonia Recovery Program (DRP)

The Dystonia Recovery Program (DRP) offers a comprehensive, neuroplasticity-based approach to managing both primary and functional dystonia. By focusing on retraining the brain’s control of movement through targeted exercises and therapies, the DRP aims at improving proper motion function.​

Our experience indicates that patients with primary, as well as functional dystonia respond particularly well to the Dystonia Recovery Program.

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Disclaimer

This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider for diagnosis and treatment of medical conditions.