Psychogenic dystonia and peripheral trauma

Area of Science:

• Neurology
• Psychiatry
• Pain Medicine

Background:

• Dystonia associated with peripheral trauma is recognized under various names, including traumatic dystonia and complex region pain syndrome (CRPS) dystonia.
• The pathophysiologic link between peripheral trauma and the development of central nervous system (CNS) changes causing dystonia is not well-established.

Purpose of the Study:

• To review the role of peripheral trauma in the development of dystonia.
• To examine four subtypes: cervical dystonia, focal limb dystonia, CRPS dystonia, and psychogenic dystonia.
• To propose an alternative conceptualization of this clinical syndrome.

Main Methods:

• Literature review focusing on the relationship between peripheral trauma and dystonia.
• Analysis of evidence for CNS structural changes induced by peripheral trauma.
• Evaluation of current treatment approaches.

Main Results:

• Evidence supporting peripheral trauma inducing structural CNS changes leading to dystonia is virtually nonexistent.
• The syndrome is more accurately defined as fixed abnormal posturing, frequently psychogenic in origin.
• Symptomatic treatments for pain and spasms can be helpful, but psychological evaluation and early intervention are crucial.

Conclusions:

• Peripheral trauma is not considered a cause of structural CNS changes leading to dystonia.
• A psychogenic origin is the most common explanation for this fixed abnormal posturing.
• Early psychological evaluation, physical therapy, and occupational therapy are vital for managing this disabling disorder.