Dystonia / Tics

Hypnotherapy notes

Some of the causes of tics have a of a physical nature and can only be resolved by medical intervention.

Where the cause is psychological or not known hypnotherapy can improve self-confidence / self-esteem, numb the affected area if required, take the focus of attention away from the problem, reduce stress and resolve underlying issues.

There may be a learned relationship between a stressful period of time and the first incidence of the tic which further increased levels of stress. Such one time learnings can be unlearned through hypnotherapy. This is particularly the case with eye twitching.

Dystonia is a syndrome of spasms and sustained contractions of the muscles. These muscle movements are not under voluntary control and they result in repetitive abnormal movements of parts of the body or persistently abnormal postures. Dystonia can affect virtually any single part of the body or several different areas at once.

What are the risks?

It is estimated that there are more than 38,000 people in the UK affected with dystonia. It can be very difficult to diagnose and many doctors will never have seen someone with it before. Therefore, the actual number of people with dystonia may be much higher than estimated.

Dystonia affects both men and women. It can affect all age groups but the most common age of onset is between 40 and 60.

It can also develop in childhood but then the pattern is generally different from adult-onset dystonia. When dystonia starts in childhood it usually begins in the leg or foot and commonly spreads to involve the entire body. If dystonia begins in adult life it tends to be more localised, usually affecting one part of the body, such as the neck or hand.

What are the causes of dystonia?

Dystonia is a movement disorder. Although the causes of dystonia are not fully known it is currently thought that the condition results from a malfunction in a part of the brain called the basal ganglia. The basal ganglia are structures situated deep in the brain. They help to regulate voluntary and involuntary movement by controlling muscle contractions in the body.

The problem may mainly lie in an area of the basal ganglia called the globus pallidus. If this area of the brain is not functioning correctly then the control of another structure in the brain called the thalamus is affected. The thalamus controls the planning and execution of movement and sends nerves to muscles via the spinal cord. The end result is that muscle co-ordination is not regulated properly. The wrong muscles will contract on movement or all muscles will contract unnecessarily causing abnormal movement and posture. Muscles positioned around joints usually work in pairs opposite each other, eg the biceps and triceps muscles of the upper arm bend or straighten the elbow respectively. Usually if one muscle of a pair is contracted the other is relaxed. However, in dystonia both muscles in the pair contract at the same time leading to the abnormal movement or posture.

It is thought that in some cases there may be a chemical imbalance or 'wiring fault' in the basal ganglia. Chemical transmitters, such as dopamine, convey messages from one nerve cell to another within the basal ganglia. If this balance is upset then incorrect signals will be sent out resulting in loss of regulation of co-ordinated movements.

Supporting this theory is the fact that people with dystonia do not showstructural abnormalities of the brain. The 'wiring fault' theory is therefore more likely because it works at a much smaller scale.

The fault in the basal ganglia may be caused by an inherited factor or be secondary to another problem such as drugs or toxins, or a separate neurological disease. Recently scanning studies using positron emission tomography (PET) in patients with cervical (neck muscle) dystonia have revealed reduced basal ganglia density of an important dopamine receptor (the D2 receptor).

How is dystonia classified?

Dystonia can be classified according to the age of onset (childhood, adolescent or adult) by body distribution (focal, multifocal, segmental, generalised or hemidystonia) or by the cause (primary, secondary, 'dystonia plus' syndromes or combinations of hereditary and degenerative causes).

Focal dystonias affect one part of the body such as eyes, neck, arm or vocal cords and are the most common type. Multifocal dystonias affect several different unrelated body parts, such as eyes, hands and vocal cords. Segmental dystonias involve two or more adjacent body parts, such as the arm and neck. Hemidystonias affect only one side of the body, and commonly result from a stroke. Generalised dystonia is more severe and can affect the entire body.

Primary dystonia refers to the situation where dystonia is the only sign and there is no identifiable cause or structural abnormality in the central nervous system.

Secondary dystonia implies there is a clear cause, such as a change in the structure of the brain, an environmental cause, as part of an inherited or acquired neurological disease or due to drugs or toxins.

'Dystonia-plus' syndromes occur when dystonia is combined with other pathological changes. It includes dopa-responsive dystonia and myoclonic dystonia.



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