Focal dystonias

• Blepharospasm is a focal dystonia of the muscles around the eye resulting in uncontrolled blinking, especially in bright light.

• Oromandibular dystonia affects the jaw, tongue and mouth resulting in jaw grinding movements and grimacing. Proper speech and swallowing may be disrupted.

• Meige's syndrome is a combination of blepharospasm and oromandibular dystonia.

Note: It must be differentiated from the buccal-lingual-facial movements of tardive dyskinesia.

• Hemifacial spasms involves involuntary, irregular muscle contractions and spasms affecting one side of the face. It usually starts with twitching around the eye and then spreads to involve all the facial muscles on one side. It is usually due to irritation of the facial nerve in its intracranial course and surgical intervention may alleviate this problem.

• Writer's cramp, typist's cramp, pianist's cramp, golfer's cramp are all occupational focal dystonias of the hand and/or forearm initiated by performing these skilled acts.

• Cervical dystonia or spasmodic torticollis is a focal dystonia of unilateral cervical muscles. It usually begins with a pulling sensation followed by twisting or jerking of the head, leading to deviation of the head and neck to one side. In early stages patients can voluntarily overcome the dystonia.

• Laryngeal or spastic dystonia is focal dystonia of laryngeal muscles resulting in a strained, hoarse or creaking voice. It may lead to inability to speak in more than a whisper.

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