Understanding Functional Dystonia

Functional dystonia is a condition that causes certain muscles to contract in a way you can’t control. Dystonia causes clenching, bending, or twisting of limbs or joints. The symptoms may start suddenly. It will feel like you can’t control the symptoms. They may get worse when you pay attention to them. And they may decrease when you are distracted from them. Functional dystonia is when there is no structural cause for the symptoms, such as a stroke.

There are 2 kinds of functional dystonia:

  • Functional episodic dystonia. This is also called functional paroxysmal dystonia. This causes symptoms that come and go for short periods of time. The areas of the body affected may change with each episode.

  • Functional fixed dystonia. This causes symptoms that last for a longer time and include pain. The part of the body that is bent or twisted can’t be moved at all.

How to say it

dihs-TOH-nee-uh

What causes functional dystonia?

Researchers don’t know yet what causes it. Tests don’t show clear physical causes, such as nerve damage. The problem may be because of changes in how the brain processes signals after different kinds of stress. Signals sent to muscles may be disordered. Functional dystonia may occur within a few months after a stressful illness or injury. People who have had a history of severe stress from sexual abuse, bullying, anxiety, or depression may be more at risk for it. But some people with functional dystonia don't have a history of these kinds of stress.

Symptoms of functional dystonia

The symptoms are muscle contractions that you can’t control. This may cause your foot or arm or another part of your body to bend or twist. These are called postures. You may also have pain in the area that is bent or twisted.

Postures may happen for a short time and then stop. Or they may stay in position for a long time. You may have one of these postures:

  • One or both feet twist inward

  • Some fingers on your hand clench or curl

  • Your wrist bends down

  • Your neck twists your head to the side

  • One shoulder is raised higher than normal, and the other lower than normal

  • Muscles in the face may spasm and pull your mouth downward

  • You may blink a lot, or close your eyes and not open them

Diagnosing functional dystonia

Your healthcare provider will ask you about your symptoms. They will ask about your health history, and any injury, illness, or life stress that you had in the last few months. You may have tests to look for problems in your brain or nerves. Tests, such as surface electromyography and electroencephalography look at how electrical signals move through your brain and nerves. You may also have an imaging test of the brain, such as an MRI or a SPECT. Tests will likely not show any clear signs of a disease. Diagnosis is made by noting a set of criteria, such as sudden start of symptoms, and symptoms that lessen with distraction.

Treatment for functional dystonia

Functional dystonia is not treated like other types of dystonia. Your treatment depends on what your healthcare provider thinks may help you best. You may be referred to a movement disorders clinic that treats functional movement disorders. Treatments that can help include:

  • Physical therapy

  • Occupational therapy

  • Cognitive behavior therapy

  • Psychotherapy

  • Medicine to help with anxiety, depression, or mood disorders

  • Stress management methods

  • Transcranial magnetic stimulation

  • Exercise

  • Hypnosis

You may also work with a pain management team. They will help lessen the muscle pain of dystonia.

Possible complications of functional dystonia

If a body part is stuck in a posture for a long time, other muscles may weaken (atrophy). This is because you may limit the way you use an arm or leg, or change how you move other parts of your body.

Living with functional dystonia

Functional dystonia can cause a lot of distress. The symptoms can cause pain and problems with daily life. They may be hard to treat. They may not go away over time. In some cases, they may get worse over time. Ask your healthcare provider about support groups in your area.

When to call your healthcare provider

Call your healthcare provider if any of the following occur:

  • Pain that gets worse
  • Symptoms that don’t get better, or get worse
  • New symptoms