Dystonia Evaluation

Dystonia is the third most common movement disorder, after essential tremor and Parkinson’s disease. But because the symptoms are so unusual and many physicians do not recognize the patterns, it’s frequently misdiagnosed.

Your diagnosis is based on a clinical evaluation by our neurologists, who all have advanced training in movement disorders. Some tests, such as blood tests or a brain MRI, can be helpful for identifying a cause. The types of tests you’ll need depend on the type of dystonia you have.


Researchers believe that dystonia results from an abnormality in, or damage to, the basal ganglia (clusters of nerve cells deep in the brain that are tightly interconnected). The basal ganglia are responsible for voluntary motor control.

The abnormality or damage could be the result of:

  • An inherited condition caused by genetic mutations (idiopathic torsion dystonia, Wilson’s disease, or dopa-responsive dystonia)
  • Exposure to certain drugs (antipsychotics and metoclopramide)
  • Birth injuries
  • Injury to the nervous system (infection, stroke, or multiple sclerosis)
  • In many cases, no specific trigger is identifiable.

Dystonia symptoms can start at any age, but usually appear between the ages of 20 and 60 (and most often between ages 30 and 50). Symptoms may be mild or severe, and they may interfere with your ability to complete daily tasks. Dystonia can affect the whole body or certain parts of the body, and symptoms vary, depending on the type of dystonia you have. 

Dystonia Symptoms

The main symptoms of dystonia are:

  • Involuntary muscle contractions that result in slow repetitive movements
  • Twisting body movements
  • Cramps
  • Abnormal posture

Symptoms also may include foot cramps, turning or dragging of the foot, worsening of handwriting, rapid eye blinking or closing, muscle tremors, and sometimes difficulty with speaking. Symptoms may become more noticeable when you’re tired or under stress.

Types of Dystonia

There are five main types of dystonia, classified by the part of the body they affect:

  • Generalized dystoniaaffects most or all of the body and frequently involves the back and trunk.
  • Focal dystoniais localized to a specific part of the body, such as the hand or eyes. Cervical dystonia, blepharospasm (involuntary muscle spasms and contractions of the muscles around the eyes), laryngeal dystonia, and writer's cramp are all examples of focal dystonia.
  • Multifocal dystoniaaffects two or more regions of the body that are not connected to each other, such as the left arm and left leg. 
  • Segmental dystoniaaffects two or more adjacent parts of the body. Cranial dystonia (involuntary contractions of the muscles of the jaw and tongue) and blepharospasm are two examples of segmental dystonia. 
  • Hemidystoniaaffects one entire side of the body. 

Dystonia can also be classified according to age at onset:

  • Early-onset generalized dystonia involves patients who develop symptoms prior to age 30. It’s characterized by the twisting of limbs. The younger the patient is at onset, the higher the likelihood that the dystonia may spread to other areas.
  • Adult-onset dystonia symptoms typically appear in patients between 40 and 60 years of age. In most cases, symptoms start in the upper body and generally don’t spread.

Evaluation Process

In order for us to accurately diagnose your dystonia, we’ll ask you to undergo a physical examination and provide a detailed medical history. We may also order a blood or urine test, magnetic resonance image (MRI), computed tomography (CT) scan, or electromyography to help with the diagnosis.

When the examination is done, we’ll provide a diagnosis and talk to you about your treatment plan and your goals. Depending on your symptoms, you may be referred to other UT Southwestern specialists. We’ll maintain an ongoing relationship with you, scheduling follow-up appointments and monitoring your progress.

Request an Appointment

To schedule an appointment with a dystonia specialist at UT Southwestern’s facilities in Dallas, or to learn more about our services, request an appointment or call 214-645-8300.