Dystonia

The dystonias are movement disorders in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures.

The movements, which are involuntary and sometimes painful, may affect a single muscle or a group of muscles such as those in the arms, legs, or neck; or the entire body.

Early symptoms of dystonia may include deterioration in handwriting after writing several lines, foot cramps, and/or a tendency of one foot to pull up or drag; this may occur “out of the blue” or may occur after running or walking some distance. The neck may turn or pull involuntarily, especially when the patient is tired or stressed. Sometimes both eyes will blink rapidly and uncontrollably, rendering a person functionally blind. Other possible symptoms are tremor and voice or speech difficulties. The initial symptoms can be very mild and may be noticeable only after prolonged exertion, stress, or fatigue. Over a period of time, the symptoms may become more noticeable and widespread and be unrelenting.

There are several types of Dystonia including Anismus, Torsion dystonia, Cervical dystonia, Blepharospasm, Oromandibular dystonia, Cranial dystonia, Focal hand dystonia, Laryngeal dystonia and Dopa-responsive dystonia (DRD) among others.

No one treatment has been found universally effective to treat all the different types of dystonia. Instead, physicians use a variety of therapies aimed at reducing or eliminating muscle spasms and pain.

Treatment has been limited to minimizing the symptoms of the disorder as there is yet no successful treatment for its cause. Reducing the types of movements that trigger or worsen dystonic symptoms provides some relief, as does reducing stress, getting plenty of rest, moderate exercise, and relaxation techniques. Various treatments focus on sedating brain functions or blocking nerve communications with the muscles via drugs, neuro-suppression or denervation. All current treatments have negative side effects and risks.

There are numerous types of medications that have proven helpful however they do come with a long list of side effects. Some of these medications can be sedating, especially at higher doses, and this can limit their usefulness.

No controlled study of marihuana in dystonic patients has been published, and the only study of cannabinoids was a preliminary open trial of cannabidiol (CBD) that suggested modest dose-related improvements in the five dystonic patients studied.(30) In mutant dystonic hamsters, however, the cannabinoid receptor agonist, WIN 55,212-2, can produce antidystonic effects.(153)

30. Consroe P, Sandyk R, Snider SR. 1986. Open label evaluation of cannabidiol in dystonic movement disorders. International Journal of Neuroscience 30:277-282.

153. Richter A, Loscher W. 1994. (+)-WIN55, 212-2 A novel cannabinoid receptor agonist, exerts antidystonic effects in mutant dystonic hamsters. European Journal of Pharmacology 264:371-377.