The Dystonias

Continuum (Minneap Minn). 2019 Aug;25(4):976-1000. doi: 10.1212/CON.0000000000000747.


Purpose of review: This article provides a summary of the state of the art in the diagnosis, classification, etiologies, and treatment of dystonia.

Recent findings: Although many different clinical manifestations of dystonia have been recognized for decades, it is only in the past 5 years that a broadly accepted approach has emerged for classifying them into specific subgroups. The new classification system aids clinical recognition and diagnosis by focusing on key clinical features that help distinguish the many subtypes. In the past few years, major advances have been made in the discovery of new genes as well as advances in our understanding of the biological processes involved. These advances have led to major changes in strategies for diagnosis of the inherited dystonias. An emerging trend is to move away from heavy reliance on the phenotype to target diagnostic testing toward a broader approach that involves large gene panels or whole exome sequencing.

Summary: The dystonias are a large family of phenotypically and etiologically diverse disorders. The diagnosis of these disorders depends on clinical recognition of characteristic clinical features. Symptomatic treatments are useful for all forms of dystonia and include oral medications, botulinum toxins, and surgical procedures. Determination of etiology is becoming increasingly important because the number of disorders is growing and more specific and sometimes disease-modifying therapies now exist.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Acetylcholine Release Inhibitors / administration & dosage
  • Adult
  • Botulinum Toxins / administration & dosage
  • Carbidopa / administration & dosage
  • Dopamine Agonists / administration & dosage
  • Drug Combinations
  • Dystonia / diagnosis*
  • Dystonia / physiopathology*
  • Dystonia / therapy
  • Dystonic Disorders / diagnosis
  • Dystonic Disorders / physiopathology
  • Dystonic Disorders / therapy
  • Female
  • Humans
  • Levodopa / administration & dosage
  • Middle Aged
  • Physical Therapy Modalities / trends


  • Acetylcholine Release Inhibitors
  • Dopamine Agonists
  • Drug Combinations
  • carbidopa, levodopa drug combination
  • Levodopa
  • Botulinum Toxins
  • Carbidopa