Symptoms vary according to the kind of dystonia involved
In most cases, dystonia tends to lead to abnormal posturing, particularly on movement. Many sufferers have continuous pain, cramping and relentless muscle spasms due to involuntary muscle movements
Early symptoms may include loss of precision muscle coordination (sometimes first manifested in declining penmanship, frequent small injuries to the hands, dropped items and a noticeable increase in dropped or chipped dishes), cramping pain with sustained use and trembling
Significant muscle pain and cramping may result from very minor exertions like holding a book and turning pages. It jon may become difficult to find a comfortable position for arms and legs with even the minor exertions associated with holding arms crossed causing significant pain similar to restless leg syndrome
Affected persons may notice trembling in the diaphragm while breathing, the need to place hands in pockets, under legs while sitting or under pillows while sleeping to keep them still and to reduce pain
Trembling in the jaw may be felt and heard while lying down and the constant movement to avoid pain may result in TMJ-like symptoms and the grinding and wearing down of teeth
The voice may crack frequently or become harsh triggering frequent throat clearing and swallowing can become difficult and accompanied by painful cramping
Electrical sensors (EMG) inserted into affected muscle groups, while painful, can provide a definitive diagnosis by showing pulsating nerve signals being transmitted to the muscles even when they are at rest
The brain appears to signal portions of fibers within the affected muscle groups at a firing speed of about 10 Hz causing them to pulsate, tremble and contort
When called upon to perform an intentional activity, the muscles fatigue very quickly and some portions of the muscle groups do not respond (causing weakness) while other portions over-respond or become rigid (causing micro-tears under load). The symptoms worsen significantly with use, especially in the case of focal dystonia, and a "mirror effect" is often observed in other body parts: use of the right hand may cause pain and cramping in that hand as well as in the other hand and legs that were not being used. Stress, anxiety, lack of sleep, sustained use and cold temperatures can worsen symptoms
Direct symptoms may be accompanied by secondary effects of the continuous muscle and brain activity including disturbed sleep patterns, exhaustion, mood swings, mental stress, difficulty concentrating, blurred vision, digestive problems and short temper
People with dystonia may also become depressed and find great difficulty adapting their activities and livelihood to a progressing disability. Side affects from treatment and medications can also present challenges in normal activities
In some cases, symptoms may progress and then plateau for years or stop progressing entirely and the progression may be delayed by treatment or adaptive lifestyle changes while forced continued use may make symptoms progress more rapidly. In others, the symptoms may progress to total disability making some of the more risky forms of treatment worth considering
An accurate diagnosis may be difficult because of the way the disorder manifests itself. Sufferers may be diagnosed as having similar and perhaps related disorders including Parkinson's Disease, Essential Tremor (ET), Carpel Tunnel Syndrome, TMJ, Tourette's Syndrome or other neuromuscular movement disorders
