Ens Teaching Review

The term dystonia was introduced in the twentieth century to describe patients with severe generalised dystonia, who were supposed to have an alteration of muscle tone (hence the etymology of this word) [1]. The clinical spectrum of dystonia is broad, yet this is one of the most under-recognised among movement disorders. Historically, the term dystonia has been used extensively by some authors to encompass postural abnormalities observed in spastic paralysis or fixed postural abnormalities [2]. The current definition of dystonia, which is based on the physiological features observed in cases of generalised dystonia [3], depicts “a syndrome of sustained muscle contractions usually producing twisting and repetitive movements or abnormal postures” [4, 5]. The resulting involuntary movement is bizarre and the patients feel pilloried by their weird quaintness; health professionals must not undervalue the resulting stigma. Most patients with dystonia have an associated psychological disturbance [6], and it is difficult to ascertain to what extent this is a consequence of the movement disorder [7, 8]. Usage of the term dystonia has long remained restricted to severe generalised forms; whereas focal forms have been described as independent movement