dystonia

ジストニア

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/02/05 02:56:45」(JST)

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Dystonias
A person with medication-induced dystonia.
Classification and external resources
Specialty	Neurology
ICD-10	G24.9
ICD-9-CM	333
OMIM	128100 224500 314250 128101 128230 602629 602124 118800 601042 128200 159900 128235 607671 607488 612067 612406 612126 611031 611147
DiseasesDB	17912
MeSH	D004421
GeneReviews	Dystonia Overview Early-Onset Primary Dystonia (DYT1)

Dystonia is a neurological movement disorder syndrome in which sustained or repetitive muscle contractions result in twisting and repetitive movements or abnormal fixed postures. The movements may resemble a tremor. Dystonia is often intensified or exacerbated by physical activity, and symptoms may progress into adjacent muscles.

The disorder may be hereditary or caused by other factors such as birth-related or other physical trauma, infection, poisoning (e.g., lead poisoning) or reaction to pharmaceutical drugs, particularly neuroleptics. Treatment must be highly customized to the needs of the individual and may include oral medications, chemodenervation botulinum neurotoxin injections, physical therapy and/or other supportive therapies, and/or surgical procedures such as deep brain stimulation.

Classification

There are multiple types of dystonia, and many diseases and conditions may cause dystonia.

Dystonia is classified by

1. Clinical characteristics such as age of onset, body distribution, nature of the symptoms, and associated features such as additional movement disorders or neurological symptoms, and
2. Cause (which includes changes or damage to the nervous system and inheritance).

Physicians use these classifications to guide diagnosis and treatment.

Types

• Generalized
• Focal
• Segmental
• Psychogenic
• Acute dystonic reaction
• Vegetative-vascular

Generalized dystonias

For example, dystonia musculorum deformans (Oppenhiem, Flatau-Sterling syndrome):

• Normal birth history and milestones
• Autosomal dominant
• Childhood onset
• Starts in lower limbs and spreads upwards

Also known as torsion dystonia or idiopathic torsion dystonia (old terminology "dystonia musculorum deformans").

Focal dystonias

Main article: Focal dystonia

These are the most common dystonias and tend to be classified as follows:

Name	Location	Description
Anismus	muscles of the rectum	Causes painful defecation, constipation; may be complicated by encopresis.
Cervical dystonia (spasmodic torticollis)	muscles of the neck	Causes the head to rotate to one side, to pull down towards the chest, or back, or a combination of these postures.
Blepharospasm	muscles around the eyes	The sufferer experiences rapid blinking of the eyes or even their forced closure causing functional blindness.
Oculogyric crisis	muscles of eyes and head	An extreme and sustained (usually) upward deviation of the eyes often with convergence causing diplopia(double vision). It is frequently associated with backward and lateral flexion of the neck and either widely opened mouth or jaw clenching. Frequently a result of antiemetics such as the neuroleptics (e.g., prochlorperazine) or metoclopramide. Can be caused by Chlorpromazine.
Oromandibular dystonia	muscles of the jaw and muscles of tongue	Causes distortions of the mouth and tongue.
Spasmodic dysphonia/Laryngeal dystonia	muscles of larynx	Causes the voice to sound broken, become hoarse, sometimes reducing it to a whisper.
Focal hand dystonia (also known as musician's or writer's cramp).	single muscle or small group of muscles in the hand	It interferes with activities such as writing or playing a musical instrument by causing involuntary muscular contractions. The condition is sometimes "task-specific," meaning that it is generally apparent during only certain activities. Focal hand dystonia is neurological in origin and is not due to normal fatigue. The loss of precise muscle control and continuous unintentional movement results in painful cramping and abnormal positioning that makes continued use of the affected body parts impossible.

The combination of blepharospasmodic contractions and oromandibular dystonia is called cranial dystonia or Meige's syndrome.

Segmental dystonias

Segmental dystonias affect two adjoining parts of the body:

• Hemidystonia affects an arm and foot on one side of the body.
• Multifocal dystonia affects many different parts of the body.
• Generalized dystonia affects most of the body, frequently involving the legs and back.

Genetic/primary

Symbol	OMIM	Gene	Locus	Alt Name
DYT1	128100	TOR1A	9q34	Early-onset torsion dystonia
DYT2	224500	HPCA	1p35-p34.2	Autosomal recessive primary isolated dystonia
DYT3	314250	TAF1	Xq13	X-linked dystonia-parkinsonism
DYT4	128101	TUBB4	19p13.12-13	Autosomal dominant whispering dysphonia
DYT5a	128230	GCH1	14q22.1-q22.2	Autosomal dominant dopamine-responsive dystonia
DYT5b	191290	TH	11p15.5	Autosomal recessive dopamine-responsive dystonia
DYT6	602629	THAP1	8p11.21	Autosomal dominant dystonia with cranio-cervical predilection
DYT7	602124	unknown	18p (questionable)	Autosomal dominant primary focal cervical dystonia
DYT8	118800	MR1	2q35	Paroxysmal nonkinesigenic dyskinesia
DYT9	601042	SLC2A1	1p35-p31.3	Episodic choreoathetosis/spasticity (now known to be synonymous with DYT18)
DYT10	128200	PRRT2	16p11.2-q12.1	Paroxysmal kinesigenic dyskinesia
DYT11	159900	SGCE	7q21	Myoclonic dystonia
DYT12	128235	ATP1A3	19q12-q13.2	Rapid onset dystonia parkinsonism and alternating hemiplegia of childhood
DYT13	607671	unknown, near D1S2667	1p36.32-p36.13	Autosomal dominant cranio-cervical/upper limb dystonia in one Italian family
DYT14	See DYT5
DYT15	607488	unknown	18p11	Myoclonic dystonia not linked to SGCE mutations
DYT16	612067	PRKRA	2q31.3	Autosomal recessive young onset dystonia parkinsonism
DYT17	612406	unknown, near D20S107	20p11.2-q13.12	Autosomal recessive dystonia in one family
DYT18	612126	SLC2A1	1p35-p31.3	Paroxysmal exercise-induced dyskinesia
DYT19	611031	probably PRRT2	16q13-q22.1	Episodic kinesigenic dyskinesia 2, probably synonymous with DYT10
DYT20	611147	unknown	2q31	Paroxysmal nonkinesigenic dyskinesia 2
DYT21	614588	unknown	2q14.3-q21.3	Late-onset torsion dystonia
DYT24	610110	ANO3	11p14.2	Autosomal dominant cranio-cervical dystonia with prominent tremor

There is a group called myoclonic dystonia where some cases are hereditary and have been associated with a missense mutation in the dopamine-D2 receptor. Some of these cases have responded well to alcohol.

Other genes that have been associated with dystonia include CIZ1, GNAL, ATP1A3, and PRRT2. Another report has linked THAP1 and SLC20A2 to dystonia.

Signs and symptoms

Play media

Hyperglycemia-induced involuntary movements, which, in this case, did not consist of typical hemiballismus but rather of hemichorea (dance-like movements of one side of the body; initial movements of the right arm in the video) and bilateral dystonia (slow muscle contraction in legs, chest, and right arm) in a 62-year-old Japanese woman with type 1 diabetes.

Symptoms vary according to the kind of dystonia involved. In most cases, dystonia tends to lead to abnormal posturing, in particular on movement. Many sufferers have continuous pain, cramping, and relentless muscle spasms due to involuntary muscle movements. Other motor symptoms are possible including lip smacking.

Early symptoms may include loss of precision muscle coordination (sometimes first manifested in declining penmanship, frequent small injuries to the hands, and dropped items), 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 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, or 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 the grinding and wearing down of teeth, or symptoms similar to temporomandibular joint disorder. The voice may crack frequently or become harsh, triggering frequent throat clearing. 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-effects 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. 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. In some cases with patients who already have dystonia, a subsequent tramatic injury or the effects of general anethesia during an unrelated surgery can cause the symptoms to progress rapidly.

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, carpal tunnel syndrome, TMD, Tourette's syndrome, conversion disorder or other neuromuscular movement disorders. It has been found that the prevalence of dystonia is high in individuals with Huntington's disease, where the most common clinical presentations are internal shoulder rotation, sustained fist clenching, knee flexion, and foot inversion. Risk factors for increased dystonia in patients with Huntington's disease include long disease duration and use of antidopaminergic medication.

Causes

Primary dystonia is suspected when the dystonia is the only sign and there is no identifiable cause or structural abnormality in the central nervous system. It is suspected to be caused by a pathology of the central nervous system, likely originating in those parts of the brain concerned with motor function, such as the basal ganglia, and the GABA (gamma-aminobutyric acid) producing Purkinje neurons. The precise cause of primary dystonia is unknown. In many cases it may involve some genetic predisposition towards the disorder combined with environmental conditions.

Secondary dystonia refers to dystonia brought on by some identified cause, such as head injury, drug side effect (e.g. tardive dystonia), or neurological disease (e.g. Wilson's disease).

Meningitis and encephalitis caused by viral, bacterial, and fungal infections of the brain have been associated with dystonia. The main mechanism is inflammation of the blood vessels, causing restriction of blood flow to the basal ganglia. Other mechanisms include direct nerve injury by the organism or a toxin, or autoimmune mechanisms.

Environmental and task-related factors are suspected to trigger the development of focal dystonias because they appear disproportionately in individuals who perform high precision hand movements such as musicians, engineers, architects, and artists. Chlorpromazine can also cause dystonia, which can be often misjudged as a seizure. Neuroleptic drugs often cause dystonia, including oculogyric crisis.

Misfunction of the sodium-potassium pump may be a factor in some dystonias. The Na+
-K+
pump has been shown to control and set the intrinsic activity mode of cerebellar Purkinje neurons. This suggests that the pump might not simply be a homeostatic, "housekeeping" molecule for ionic gradients; but could be a computational element in the cerebellum and the brain. Indeed, an ouabain block of Na+
-K+
pumps in the cerebellum of a live mouse results in it displaying ataxia and dystonia. Ataxia is observed for lower ouabain concentrations, dystonia is observed at higher ouabain concentrations. A mutation in the Na+
-K+
pump (ATP1A3 gene) can cause rapid onset dystonia parkinsonism. The parkinsonism aspect of this disease is thought to be attributable to malfunctioning Na+
-K+
pumps in the basal ganglia; the dystonia aspect is thought to be attributable to malfunctioning Na+
-K+
pumps in the cerebellum (that act to corrupt its input to the basal ganglia) possibly in Purkinje neurons.

Filip et al 2013: "Although dystonia has traditionally been regarded as a basal ganglia dysfunction, recent provocative evidence has emerged of cerebellar involvement in the pathophysiology of this enigmatic disease. It has been suggested that the cerebellum plays an important role in dystonia etiology, from neuroanatomical research of complex networks showing that the cerebellum is connected to a wide range of other central nervous system structures involved in movement control to animal models indicating that signs of dystonia are due to cerebellum dysfunction and completely disappear after cerebellectomy, and finally to clinical observations in secondary dystonia patients with various types of cerebellar lesions. It is proposed that dystonia is a large-scale dysfunction, involving not only cortico-basal ganglia-thalamo-cortical pathways, but the cortico-ponto-cerebello-thalamo-cortical loop as well. Even in the absence of traditional "cerebellar signs" in most dystonia patients, there are more subtle indications of cerebellar dysfunction. It is clear that as long as the cerebellum's role in dystonia genesis remains unexamined, it will be difficult to significantly improve the current standards of dystonia treatment or to provide curative treatment."

Treatment

Reducing the types of movements that trigger or worsen dystonic symptoms provides some relief, as does reducing stress, getting plenty of rest, moderate exercise, and relaxation techniques. Various treatments focus on sedating brain functions or blocking nerve communications with the muscles via drugs, neuro-suppression, or denervation. All current treatments have negative side-effects and risks.

Physical intervention

While research in the area of effectiveness of physical therapy intervention for dystonia remains weak, there is reason to believe that rehabilitation will benefit patients with dystonia. Physical therapy can be utilized to manage changes in balance, mobility and overall function that occur as a result of the disorder. A variety of treatment strategies can be employed to address the unique needs of each individual. Potential treatment interventions include splinting, therapeutic exercise, manual stretching, soft tissue and joint mobilization, postural training and bracing, neuromuscular electrical stimulation, constraint-induced movement therapy, activity and environmental modification, and gait training.

A patient with dystonia may have significant challenges in activities of daily living (ADL), an area especially suited for treatment by occupational therapy (OT). An occupational therapist (OT) may perform needed upper extremity splinting, provide movement inhibitory techniques, train fine motor coordination, provide an assistive device, or teach alternative methods of activity performance to achieve a patient's goals for bathing, dressing, toileting, and other valued activities.

Recent research has investigated further into the role of physiotherapy in the treatment of dystonia. A recent study showed that reducing psychological stress, in conjunction with exercise, is beneficial for reducing truncal dystonia in patients with Parkinson’s Disease. Another study emphasized progressive relaxation, isometric muscle endurance, dynamic strength, coordination, balance, and body perception, seeing significant improvements to patients’ quality of life after 4 weeks.

Since the root of the problem is neurological, doctors have explored sensorimotor retraining activities to enable the brain to "rewire" itself and eliminate dystonic movements. The work of several doctors such as Nancy Byl and Joaquin Farias has shown that sensorimotor retraining activities and proprioceptive stimulation can induce neuroplasticity, making it possible for patients to recover substantial function that was lost due to Cervical Dystonia, hand dystonia, blepharospasm, oromandibular dystonia, dysphonia and musicians' dystonia.

Some focal dystonias have been proven treatable through movement retraining in the Taubman approach, particularly in the case of musicians. However other focal dystonias may not respond and may even be made worse by this treatment.

Due to the rare and variable nature of dystonia, research investigating the effectiveness of these treatments is limited. There is no gold standard for physiotherapy rehabilitation. To date, focal cervical dystonia has received the most research attention; however, study designs are poorly controlled and limited to small sample sizes.

Medication

Different medications are tried in an effort to find a combination that is effective for a specific person. Not all people will respond well to the same medications. Medications that have had positive results in some include: diphenhydramine, benzatropine and atropine. anti-Parkinsons agents (such as ropinirole and bromocriptine), and muscle relaxants (such as diazepam).

Anticholinergics

Medications such as anticholinergics (benztropine), which act as inhibitors of the neurotransmitter acetylcholine, may provide some relief. In the case of an acute dystonic reaction, diphenhydramine is sometimes used (though this drug is well known as an antihistamine, in this context it is being used primarily for its anticholinergic role).. See also Procyclidine.

Baclofen

A baclofen pump has been used to treat patients of all ages exhibiting muscle spasticity along with dystonia. The pump delivers baclofen via a catheter to the thecal space surrounding the spinal cord. The pump itself is placed in the abdomen. It can be refilled periodically by access through the skin. Baclofen can also be taken in tablet form

Botulin toxin injection

Botulinum toxin injections into affected muscles have proved quite successful in providing some relief for around 3–6 months, depending on the kind of dystonia. Botox or Dysport injections have the advantage of ready availability (the same form is used for cosmetic surgery) and the effects are not permanent. There is a risk of temporary paralysis of the muscles being injected or the leaking of the toxin into adjacent muscle groups, causing weakness or paralysis in them. The injections have to be repeated, as the effects wear off and around 15% of recipients will develop immunity to the toxin. There is a Type A and a Type B toxin approved for treatment of dystonia; often, those that develop resistance to Type A may be able to use Type B.

Muscle relaxants

Clonazepam, an anti-seizure medicine, is also sometimes prescribed. However, for most, their effects are limited and side-effects like mental confusion, sedation, mood swings, and short-term memory loss occur.

Parkinsonian drugs

Dopamine agonists: One type of dystonia, dopamine-responsive dystonia, can be completely treated with regular doses of L-DOPA in a form such as Sinemet (carbidopa/levodopa). Although this does not remove the condition, it does alleviate the symptoms most of the time. (In contrast, dopamine antagonists can sometimes cause dystonia.)

Surgery

Surgery, such as the denervation of selected muscles, may also provide some relief; however, the destruction of nerves in the limbs or brain is not reversible and should be considered only in the most extreme cases. Recently, the procedure of deep brain stimulation (DBS) has proven successful in a number of cases of severe generalised dystonia. DBS as treatment for medication-refractory dystonia, on the other hand, may increase the risk of suicide in patients. However, reference data of patients without DBS therapy are lacking.

History

The clinical features of dystonia were first reported in detail in 1911, when Hermann Oppenheim, Edward Flatau and Wladyslaw Sterling described some Jewish children affected by a syndrome that was retrospectively considered to represent familial cases of DYT1 dystonia. Some decades later, in 1975, the first international conference on dystonia was held in New York. It was then recognized that, in addition to severe generalized forms, the dystonia phenotype also encompasses poorly-progressive focal and segmental cases with onset in adulthood, such as blepharospasm, torticollis and writer’s cramp. These forms were previously considered independent disorders and were mainly classified among neuroses. A modern definition of dystonia was worded some years later, in 1984. During the following years it became evident that dystonia syndromes are numerous and diversified, new terminological descriptors (e.g., dystonia plus, heredodegenerative dystonias, etc.) and additional classification schemes were introduced. The clinical complexity of dystonia was then fully recognized.

See also

• Extrapyramidal symptoms
• Hypertonia
• Sensory trick
• Sydenham's chorea
• Ulegyria (brain condition with dystonia symptoms)

References

External links

• GeneReview/NIH/UW entry on Dystonia Overview
• GeneReviews/NCBI/NIH/UW entry on Early-Onset Primary Dystonia
• Film on Dystonia from Public Broadcasting Service
• A story of one woman's struggle with dystonia at MSNBC.com
• Care4Dystonia Newsletters, Library and Education Forum on Dystonia
• Down on the Pharm': All About Acute Dystonic Reaction
• The European Dystonia Association with information, links and support

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. ジストニアの分類および評価 classification and evaluation of dystonia
• 2. ジストニアの治療 treatment of dystonia
• 3. 小児における運動過多な運動障害 hyperkinetic movement disorders in children
• 4. 機能性不随意運動 functional movement disorders
• 5. 遅発性ジスキネジア：臨床的特徴および診断 tardive dyskinesia clinical features and diagnosis

English Journal

• Heterozygous mice deficient in Atp1a3 exhibit motor deficits by chronic restraint stress.

• Sugimoto H1, Ikeda K2, Kawakami K3.
• Behavioural brain research.Behav Brain Res.2014 Oct 1;272:100-10. doi: 10.1016/j.bbr.2014.06.048. Epub 2014 Jun 29.
• Dystonia is a neurological disorder with involuntary and simultaneous contractions of agonist and antagonist muscles. Rapid-onset dystonia parkinsonism (RDP), one of the heredity forms of dystonia, is caused by mutations of Na,K-ATPase α3 subunit gene (ATP1A3). The abrupt onset of bulbar and limb s
• PMID 24983657

• Physiologic changes associated with cerebellar dystonia.

• Shakkottai VG.
• Cerebellum (London, England).Cerebellum.2014 Oct;13(5):637-44. doi: 10.1007/s12311-014-0572-5.
• Dystonia is a neurologic disorder characterized by sustained involuntary muscle contractions. Lesions responsible for unilateral secondary dystonia are confined to the putamen, caudate, globus pallidus, and thalamus. Dysfunction of these structures is suspected to play a role in both primary and sec
• PMID 24879387

• Normal Motor Adaptation in Cervical Dystonia: A Fundamental Cerebellar Computation is Intact.

• Sadnicka A1, Patani B, Saifee TA, Kassavetis P, Pareés I, Korlipara P, Bhatia KP, Rothwell JC, Galea JM, Edwards MJ.
• Cerebellum (London, England).Cerebellum.2014 Oct;13(5):558-67. doi: 10.1007/s12311-014-0569-0.
• The potential role of the cerebellum in the pathophysiology of dystonia has become a focus of recent research. However, direct evidence for a cerebellar contribution in humans with dystonia is difficult to obtain. We examined motor adaptation, a test of cerebellar function, in 20 subjects with prima
• PMID 24872202

Japanese Journal

• Cortical activities associated with voluntary movements and involuntary movements.

• Shibasaki Hiroshi
• Clinical neurophysiology 123(2), 229-243, 2012-02
• … The sensorimotor cortex (S1-M1) was shown to play an important role in generation of cortical myoclonus, essential tremor, Parkinson tremor and focal dystonia. …
• NAID 120003824943

• Three cases of focal embouchure dystonia: classifications and successful therapy using a dental splint

• Satoh Masayuki,Narita Motoshi,Tomimoto Hidekazu
• EUROPEAN NEUROLOGY 66(2), 85-90, 2011-09
• NAID 120003373768

Related Links

• Dystonias Fact Sheet - National Institute of Neurological ...

Dystonias information page compiled by the National Institute of Neurological Disorders and Stroke (NINDS). ... What is dystonia? Dystonia is a disorder characterized by involuntary muscle contractions that cause slow ...

• Dystonia: MedlinePlus - National Library of Medicine ...

Dystonia is a movement disorder that causes involuntary contractions of your muscles. These contractions result in twisting and repetitive movements. Sometimes they are painful. Dystonia can affect just one muscle, a ...

Related Pictures

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★リンクテーブル★

リンク元	「不随意運動」「サンディファー症候群」「dystonic disorder」「ジストニア」「dystonic」
拡張検索	「primary dystonia」「adult-onset dystonia」「secondary dystonia」「psychogenic dystonia」「autonomic dystonia」

「不随意運動」

　　[★]

英

involuntary movement IVM

関

不随意筋

不随意運動と大脳基底核との関連

		大脳基底核の障害との関連	特徴	好発部位	代表疾患
振戦	tremor	黒質	律動的な振動運動	指、手	Parkinson病 本態性振戦
舞踏病様運動	choreiform movement	尾状核	不規則で、目的のない、非対称性運動 [show details] <youtube>http://www.youtube.com/watch?v=JzAPh2v-SCQ</youtube>	顔面、四肢	Huntington舞踏病
バリズム	ballism/ballismus	視床下核	舞踏様病の一種。運動はより急速、粗大、持続性。四肢の抹消よりも体幹に誓い部分に強く起こり、上下肢を投げ出すよう激しい運動 [show details] <youtube>http://www.youtube.com/watch?v=Cn3WSt6omzY</youtube>	四肢	視床下核 Juys体の出血・梗塞
アテトーゼ	athetosis	赤核、被殻、淡蒼球	舞踏病よりゆっくりで、持続性のある運動。舞踏病に比べ一定の運動。虫が這うような運動。 [show details] <youtube>http://www.youtube.com/watch?v=I63SobW58J0</youtube>	手・指	脳性麻痺 CO中毒 レンズ核障害
ミオクローヌス	myoclonus	赤核	1つまたは多くの筋の短時間の不随意な収縮。関節や四肢の強い運動を伴わないのが原則 [show details] <youtube v=faiVIKmmi5k></youtube>	全身・局所	Creutzfeldt-Jakob病 Ramsay Hunt症候群 てんかん リピドーシス ミトコンドリア脳筋症
痙攣	cramp/convulsion		筋肉が不随意に，激しく攣縮する状態
ジストニー	dystonia		異常姿勢。筋緊張の亢進で異常な姿勢となり、体幹の捻転、胸郭の傾斜、頚の捻転、肘の過伸展、手首の過屈曲、指の過伸展などを呈する。 [show details] <youtube v=1MQtaMENDV0></youtube>	体幹・近位筋	捻転ジストニー
チック	tic		顔、頚部、肩などに起こる、比較的急激で、繰り返して起こる運動 [show details] <youtube>http://www.youtube.com/watch?v=xIAbmfxIm6I</youtube>	顔面	てんかん 緊張

「サンディファー症候群」

　　[★]

英

Sandifer syndrome

• 裂孔ヘルニアと、痙性斜頚(spasmodic torticollisとジストニア(dystonia)のような頚部症状を呈する症候群

参考

• 1. wiki en

• http://en.wikipedia.org/wiki/Sandifer_syndrome

「dystonic disorder」

　　[★]

筋緊張異常疾患、ジストニア

関

adult-onset dystonia、dystonia、dystonic、focal dystonia、primary dystonia、psychogenic dystonia、secondary dystonia、writer's cramp

「ジストニア」

　　[★]

英

dystonia

同

ジストニー、異緊張症

関

不随意運動

<youtube v=1MQtaMENDV0></youtube>

「dystonic」

　　[★]

• 筋緊張異常の、ジストニアの

関

dystonia、dystonic disorder

「primary dystonia」

　　[★]

原発性ジストニア

関

adult-onset dystonia、dystonic disorder、focal dystonia、psychogenic dystonia、secondary dystonia、writer's cramp

「adult-onset dystonia」

　　[★]

成人発症ジストニア

関

dystonic disorder、focal dystonia、primary dystonia、psychogenic dystonia、secondary dystonia、writer's cramp

「secondary dystonia」

　　[★]

二次性ジストニア

関

adult-onset dystonia、dystonic disorder、focal dystonia、primary dystonia、psychogenic dystonia、writer's cramp

「psychogenic dystonia」

　　[★]

心因性ジストニア

関

adult-onset dystonia、dystonic disorder、focal dystonia、primary dystonia、secondary dystonia、writer's cramp

「autonomic dystonia」

　　[★]

自律神経失調症、自律神経失調

関

autonomic imbalance