Reaching a point of diagnosis in too many cases is a long and hard road to travel down. Despite being the third most common movement disorder there is an astounding lack of knowledge in the medical community. The lucky minority may get a diagnosis in months, but for most it takes years, sometimes decades.
In a way I was lucky that I had heard the word Dystonia once before, though I had no appreciation of its signifinance. Looking back at my medical history I had symptoms long before I realised there was anything potentially wrong. In 2008/2009 I developed severe neck spasms, however this kicked off after a rather spectacular fall from a horse which resulted in me landing on my head, so it was easy to put the spasms down to this. Then in 2010 I experienced for the first time Oromandibular Dystonia. My jaw dramatically deviated for a painful 3 months before we found a maxiofacial consultant surgeon who knew what was wrong. I was informed that a quick operation where my tempromandibular joint (TMJ) would be washed out and botox administered would solve the problem. I never questioned this and presumed that Dystonia must be some sort of infection. This belief was reaffirmed by the fact that the operation was a success. Shortly after this I developed arm and back spasms, but for several years I shook these off as simply violent shivers.
In the summer of 2012 I was coming to an end of my first year of midwifery training. For a couple of days I’d had ear ache and swelling and had planned to visit the GP but was in no rush to do so. I now recognise this as a sign of whenever my jaw is going to play up. That weekend I’d popped home to visit my family, whilst relaxing in the garden with them my jaw started to spasm and once again deviate. My mum offered to drive me to the local hospital which I declined, convinced it was just an infection.
My GP that Monday was horrified. After one look at me I was on the way to the hospital with her convinced I had had a stroke. Countless blood tests and xrays were taken, and eventually a consultant appeared. He was the top bod in his area and had an ego to match. Due to his station I didn’t question his plan to wire my jaw shut. Less than 24 hours after the operation my flatmates were rushing my back to hospital, the spasms had returned with vengeance, breaking every wire in my mouth and dislocating my jaw. From that moment onwards the consultant dodged me. Refusing to see me or remove the wires which were ripping my mouth apart.
It took a further 3 months to find a surgeon willing and able to help me. Sitting in front of the surgeon who had treated me back in 2010 he was apologetic for the state I was in. By this point we had started researching Dystonia as I was now wheelchair bound and unable to brush my hair or feed myself.
I often wonder whether 5 years on I would have received my diagnosis if I had never met my neuro. The Dystonia Society UK have a wealth of information that has been invaluable. It’s enabled me to ask for treatment and referrals appropriate for my conditions and have informed conversations with doctors.
I never expected to still be fighting for correct care. The current hospital I am in would far rather blame my symptoms on past traumas than acknowledge the existence of Dystona. It makes me thankful daily that I have a neurologist willing to my corner.
The exact cause as to why people develop Dystonia is currently unknown for the majority of people. For a small group of people it occurs due to a gene mutation, brain injury, infection, secondary disorder, or as a result of medication. Pinning down the root of the condition is something that research is currently focusing on.
So far we know that for some unidentified reason there is an issue with a section of the brain called the Basal Ganglia. It is known that this region of the brain enhances activity in the motor cortex which controls the agonist and antagonist muscles. In a healthy person when they make a movement the way the muscles contract and relax is coordinated and harmonious. However with Dystonia there is a deficient inhibition in the antagonist muscles which can result in both sets of muscles contracting simultaneously. It’s not clear why this happens.
The Dystonia Society UK have a fantastic wealth of information on the ins and outs of Dystonia, which I would really recommend reading to find out more information on the condition. For now it seems unlikely that any one particular theory will be proven right in the immediate future, so I shall continue to personify my Dystonia into a cheeky little alien, it’s a far more entertaining cause.
It’s currently the 2017 Dystonia Awareness Week in the United Kingdom. Usually I would have kicked off awareness week on time (yesterday) with a blog post, and as has become tradition, would have been sporting some lovely green streaks in my hair. Instead I’m currently in the hospital due to a flare up of my Dystonia; at least the timing is appropriate and they’ve given me some sexy green slipper socks (so I’m squeezing the go green awareness campaign in).
Currently The Dystonia Society UK estimates that around 70,000 people are affected by the condition, making it the third most common movement disorder in the UK, however it’s thought that the affected number of people affected may be far higher due to a lack of knowledge within the profession affecting levels of correct diagnosis. Dystonia presents in a vast amount of varying ways across all age groups which adds to the complications when it comes to diagnosing patients.
Only a few decades ago it was thought that Dystonia was caused by psychogenic roots, thankfully through giant leaps forwards in research we now know that this isn’t the case; many people will never know what triggered their condition, whilst others now know that their Dystonia is caused by either a genetic mutation or brain trauma. Sadly despite the leaps in understanding of the condition many medical professionals still mistake this as psychogenic condition and therefore do not treat the patient appropriately.
This is one of the reasons that awareness week is so vital, without awareness and fund rasing events research into causes and treatment options comes to a halt. At this moment in time there is no known cure for Dystonia, but treatment can have a significant impact in a sufferers quality of life.
Though out awareness week I’m aiming to blog daily, however this may alter depending on how well I am.
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