1. Primary

2. Secondary

1. Dystonic Characteristics

• slow, involuntary, repetitive movements causing exaggerated twisting and posturing of various muscle groups
  • extremities
  • axial musculature
  • cranial and cervical muscles
• may also involve segmental dystonia
  • writer's cramp
  • blepharospasm
  • buccomandibular dystonia
• focal, hemidystonic, or generalized

2. Features Suggestive of Secondary Etiology

• onset in infancy
• acute or sudden onset
• presence of dystonia at rest from onset
• unilateral involvement or hemidystonia
• absence of family history of dystonia, tremor, or other movement disorders
• exposure to risk factors: drugs, trauma, infection

3. Tics Caused by Birth Asphyxia

• delayed onset of dystonia - mean age of onset is 12.9 yrs
• types of dystonia observed:
  • generalized, hemidystonic, segmental brachial
• tend to evolve into generalized dystonia
• other associated neurologic manifestations:
  • developmental delay, hyperreflexia, dysmetria, focal weakness
• respond well to high-dose artane (anti-cholinergic)

4. Tics Caused by Trauma

• head, neck, peripheral nerve trauma
• types of dystonia observed:
  • generalized, hemidystonic, cervical
• other associated neurologic manifestations:
  • hemiparesis, aphasia, seizures
• usually respond poorly to medical and surgical therapy

1. Serum

• CBC, ESR, electrolytes, gas, copper, ceruloplasmin
• ANA, protein electrophoresis
• serum lactate, pyruvate, amino acids
• biopterin, homovanillic acid

2. Urine

• screen for amino acids, organic acids, and oligosaccharides

3. Imaging Studies

• MRI/CT/PET

4. Others

• EEG
• muscle biopsy
• psychometric testing

1. Primary Dystonias

2. Secondary Dystonias

• correct underlying disorder
• remove offending drug - i.e., benadryl 1-2 mg/kg/dose IV
• treat dystonias