Psychogenic dystonia and peripheral trauma

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Dystonia in association with peripheral trauma is a well-described clinical syndrome. The syndrome goes by many names—“traumatic” dystonia, “fixed” dystonia, peripherally induced dystonia, or complex region pain syndrome (CRPS) dystonia. We reviewed the role of peripheral trauma in the development of dystonia, focusing on 4 subtypes—cervical dystonia, focal limb dystonia, CRPS dystonia, and psychogenic dystonia. We show that peripheral trauma inducing, provoking, or precipitating structural changes within the CNS leading to dystonia is not an accepted concept, and current evidence supporting a pathophysiologic mechanism is virtually nonexistent. A better approach to this clinical syndrome is to define it as fixed abnormal posturing that is most commonly psychogenic. While symptomatic treatment of pain and spasms with medication can be beneficial, early psychological evaluation and patient-specific treatment is important. Modalities such as physical and occupational therapy should be utilized early. Finally, it should be emphasized that like many psychogenic movement disorders, it remains a highly disabling and distressing disorder.GLOSSARY:CRPS: complex region pain syndromeDSM-IV: Diagnostic and Statistical Manual of Mental Disorders, 4th editionGABA: γ-aminobutyric acid

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