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Cervical dystonia case

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https://www.youtube.com/my_videos?o=U

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On November 21, 2011, Dr.Fan got a special call from a patient’s close friend, invited Dr.Fan to see a deep coma patient in INOVA Fairfax hospital neuroscience ICU ward. The visit was approved by that facility and its attending doctor.

The patient is a 67-years old gentleman who is a main minister of a local Indian Sikh temple. He got a hemorrhagic stroke in his brain stem area seven days ago when he did some home repairing.  The hematoma was large and he had an emergency surgery when he was sent to ER by an ambulance. When I saw him, he had no any reflection and no any reaction to strong stimulation. His respiration was irregular and had to use breath machine. He had fever, 102 degree F. He was under antibiotics and respiration stimulating medication.

Considering: Stroke, Bi Pattern(闭证).

I gave him An Gong Niu Huang pills(dissolve in warm water, once every 8 hours, i.g.), and did acupuncture for him.

Acupuncture points were: Ren Zhong, Yin Tang, Feng Chi, He Gu, Qu Chi, Ba Xie, Ba Feng, Zu San Li, Yong Quan. The stimulation was about one hour.

November 22, 2011: seemed have some effects. patient very occasionally move his leg slightly when I stimulated his Yong Quan points.

November 23, 2011: patient had more reaction to acupuncture, the frequency of moving his leg, fingers, head, slight more than one day ago.

November 24, 2011: condition was same as before. The tube from skull to test ICP removed.

November 25, 2011(5th treatment): patient was still in deep coma, responding to acupuncture stimulation more often, seem every 5-10 stimulation he could have a responding.  Stopping use antibiotics and respiration stimulating medication. The iv tube to central vein was removed and only used iv tube in arm vein.

November 26, 2011(6th treatment): patient was moved to Intermediate Unit from ICU. The condition was not good as yesterday. The doctor there discussed patient’s condition with his family members, suggested that this patient was still in very critical condition and his future was not so optimistic. Patient’s family members seemed considering give-up.

I did not give patient more treatments since then.

During six days I involved in his treatments, I feel Chinese medicine, included in An Gong Niu Huang Pills and acupuncture did show some effects, such as some responds to pain stimulation(relection recovered a little bit). However, this patient’s condition is too severe, he didn’t recover from the deep coma.

Although this invitation was by patient’s family and close friends, the facility and doctor in ICU did allow the doctor or practioner in Chinese medicine /acupuncture to see and treat patient. This is much open than a few years ago.

I remember, I saw a coma patient in Johns Hopkins Hospital two years ago, that facility did not allow patient to use Chinese herbal medicine, which needs special approval by hospital administration (the procedure would take half-year).

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Last Sunday I had a lecture for alumni Association of Chinese Medicine in Washington DC. The topic is Liu Wei Di Huang Wan 六味地黄丸.

Here is my Power Point file.六味地黄

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Case 1. from New Jersey State,Mom’s e-mail: d….M……i@aol.com

The patient- C…… is a 10 year old girl with Dystonia in her right leg and foot.  The (LiuJunSan Capsule) pills seem to improve tics that are related (facial and neck, arms). Not too much improved for her leg dystonia yet.

She only used two bottles of capsule (dose: 2 capsule, 3 time a day), did not use acupuncture and Chinese herbal tea.
Case 2. From California,
Before using our Chinese herbal tea and LiuJunSan Capsule, patient had one month treatment in local. Used acupuncture and Chinese herbal tea from local doctors, he felt not so satisfactory.
Use two month Chinese herbal tea we provided, he feels much better.
Case 3. From Washington State.
He has got “better”, but both patient or any healthcare provider could not assess the effectiveness because he has used almost all therapies in same time, included in Chinese herbal tea we provided(did not use very seriously), LiuJunSan capsule we provided, two “western” medications, Botox injections, massage, acupuncture(3 times a week), and work less hours. He seems too anxious, and try to cure it very soon.
Case.4 From Virginia State,
Patient see me and use acupuncture and Chinese herbal tea with the LiuJunSan capsule, yesterday was the second visit, her neck movement ranges have been improved.

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Everyday, I answer many questions from visited patients or online inquiries, such as:

For some chronic or difficult-to-treat conditions, such Dystonia, or Parkinson Disease, or diabetes, or a mix of many conditions,

“How many sessions’ acupuncture could cure my condition?”

“How much percentage of cure rate of your treatment?”

“I have infertility, how many sessions’ acupuncture could help me get pregnant?”

And, “If you say you could cure it, I will see you.”

Actually, many conditions or illness,disorders are chronic conditions, many of them are difficult-to-treat also, and patients may use conventional medicine for years too.

Frankly, I say “we could not cure most of them”,  in 8 sessions, even in 16 sessions’acupuncture; Or in one month herbal tea treatment. Many of them need long-term management.

We do see some magic results in some cases; we did cure some patients in a very short-term treatments. In a few cases, we even cure the patients’ condition, which they had that for years, with only one or two sessions’ acupuncture or in one day’s herbal tea treatment!

We did see pregnant only after one acupuncture treatment in a few patients with infertility. We did stop the dystonia in one week.

However, for most of the cases, we could improve them; some patients also did get disappointed with our treatments, because their aims did not become the real in one or two month, or other short period of time.

We do tell patients who have difficult-to- treat illness or disorders, they will see some of improvements over the time, some illness or disorders could not be cured in 100% of patients:  some may get “cure”(this is clinically cure, not absolute cure as patient hoped, sometime may get relapse if patients get some trigger), some get improved, some get slight better(or other condition get better, for example, overall condition better), some no result, some worse (please note, the illness, or disorder will get worse under some conditions by itself, not related to acupuncture or Chinese herbs at all).

We could not imagine how many percentage of the patients get “cure”.  For example, we have over 40 patients get pregnant in recent 4 years. We may say about 40-50% of patients (if they had 2 month or more serious treatments) get pregnant!

However, this is a very rough answer. Why? the condition is very complicated.

In these patients who seek acupuncture/herbs for fertility, patients had different causes of infertility, such as FSH high, POCS, ovulation issue, progesterone issue, tube issue, husband sperm issue, etc; many patients had medications, some of them did acupuncture alone, some of them had Chinese herbs too; some of them followed regular treatment strategy, some of them didn’t follow our strategy very well(due to work, due to personal issue, due to something else–subjective or objective reasons); some of them had IVF, IUI etc(with acupuncture or herbs). We could not tell you very detail in a statistic work.

However, it does work!

For acupuncture and Chinese herbology, to many difficult-to-treat illness or disorders, it works! at least it improves patients’ condition in most of the cases.

Importantly, acupuncture basally has little adverse effect. Chinese herbology also has very less side effect if patients see a trained Chinese medicine doctor.

For most of patients with chronic or difficult-to-treat conditions, no.one thing is adjusting the aim based on understanding their own condition well, don’t see a Chinese medicine doctor – he or she promised you–you will get a cure in several treatments(except for some pain condition). Most of time, patients will need more longer treatments.

Be patient.

For the cost-effectiveness, don’t see a provider who promise you have a good result but you pay very little.Most of well-trained, experienced Chinese medicine doctors offer patients a reasonable, affordable fee schedule. For better result, don’t see a provider who had less training and over low fee.

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I find a website which reports me using my several videos.

http://wn.com/DrArthurFan

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1. One gentleman who lives in LA visited me in last week. He has mouth and tongue (etc.) dystonia for many years. He has Botox injections, which helped to diminish the symptoms in some extents. The patients had one month herbal tea (we mailed herbs to him) and two months’ capsule, as well as 20 sessions’ acupuncture (in LA).

His personal experience is acupuncture (did in LA by a local acupuncturist) did not help him very much, the herbal tea seems help his more. During the herbal tea treatment (with acupuncture), he had more relieve in dystonia. He had acupuncture in our office once a day for three days, during that short period, we did not find a significant improvement.

He decide to use herbal tea and acupuncture for a few months and see if Chinese medicine could help him to overcome his dystonia.

Dr.Fan notes: Some of patients may respond the herbal tea better than that in acupuncture.However, some patients have better response in acupuncture. Basically, I recommend acupuncture plus herbal tea. Some time the capsule LIU JUN SAN also plays a good rule.

2. One middle age woman who has neck dystonia, or we call it Crooked, Twisted Neck Cervical Dystonia, or Spasmodic Torticollis (ST). She had to use muscle relaxant and 4 or more tablets of Ibuprofen everyday. After our acupuncture (with LIU JUN SAN capsule) for about 8 sessions, she could have 4 to 5 days pain relief (still use muscle relaxant) per week, and dystonia very less (self report “50% improvement”). She still uses Ibuprofen in 2-3 days/week, but the amount drops to 2 tablets a day. She is still in treatment–acupuncture, twice a week. Due to some reasons, she does not use herbal tea.

3. One young man with Spasmodic Torticollis who lives in Columbia, had Botox injection which leads a partial symptom relief. Using herbal tea and LIU JUN SAN one treatment course(one month), he feels better. So we decide to start the second course herbal tea plus LIU JUN SAN capsule today.

4.One young woman with both hands/fingers dystonia(right hand worse). She has used Botox injection for long time. She has seen me for three years and has used LIU JUN SAN capsule in some times. Yesterday, she came again and still just for LIU JUN SAN. Her experience is LIU JUN SAN capsule helps in eliminating the partial dystonia which Botox injection does not work, i.e. She feels Botox injection plus LIU JUN SAN capsule help more than Botox alone.

5. Three women with Spasmodic Torticollis who had acupuncture here for many years and recovered very well, still come for “tun up” acupuncture, i.e. once 2 weeks or one month. Still using LIU JUN SAN sometime as maintaining treatments.

Dr.Fan notes: Acupuncture at least could work on relaxation, adjusting the neurological function(such as work on Dopamine system,etc), as well as treating the pain and spasm from dystonia. Herbology is more complicated, according to our data, our special herbal formula for dystonia (“tea” and capsule) could diminish the dystonia and very stable.

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Read Detail online at

http://www.jstage.jst.go.jp/article/jkpt/6/0/103/_pdf

 
ONLINE ISSN : 1349-9572
PRINT ISSN : 1346-9606
Journal of Kansai Physical Therapy
Vol. 6 (2006) 103-107
[PDF (410K)] [References

 

Influence of Acupuncture Stimulus of Left L14 (Goukoku) on Reaction Time of the Left Sternocleidomastoid
Hidenori SAKAI1)3), Makiko TANI2), Etsuko NISHIMURA3), Ai UEDA3), Ayako FUKUSHIMA3), Hironori INOUE3), Aya TAKADA3) and Toshiaki SUZUKI2)
1) Department of Rehabilitation, Kiba Hospital
2) Research Center of Neurological Diseases, Kansai College of Oriental Medicine
3) Trainee Acupuncturist, Outpatient Clinic, Kansai College of Oriental Medicine

(Received: 2006/10/13)
(Accepted for publication: 2006/11/17)

 

Abstract
According to acupuncture therapy for dystonia patients practised at the Outpatient Clinic, Kansai College of Oriental Medicine, there is a report that remote acupuncture therapy by the meridian concept is effective. It was reported that dystonia is sensory defect rather than dyskinesia, and we report acupuncture therapy of soft stimulus to normalize the upper central nervous system for stimulated sensory nerve. Based on the meridian theory, we investigated the influence of acupuncture stimulus to the sternocleidomastoid muscle (L14) through which the large intestine meridian (L1) passes on the hand, on the central nervous system and muscles by comparison of surface EMGS among 3 groups: no stimulus, 5 min stimulus, 20 min stimulus. After 20 min stimulus, both PMT and MT were significantly shortened compared with before stimulus. However, in the no stimulus and 5 min stimulus groups there were no differences in PMT and MT compared with before stimulus. This suggests that to excite the central nervous system and muscle function via the sternocleidomastoid muscle, 20 min acupucture is needed.

Key words: L14 (Goukoku), sternocleidomastoid muscle, acupuncture stimuius, reaction time

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See detail, click the link:

http://www.youtube.com/watch?v=cOE19MfFStY

www.ChineseMedicineDoctor.US

For more Videos, please click:

http://www.youtube.com/my_videos?feature=mhw5

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Patient’s e-mail:

-On Sunday, October 24, 2010 1:30 PM

From:”L. M.” <l…..@hotmail.com>
Dr Fan,
Thank you for checking on us.  My daughter’s condition, after 6 months taking Liu Jun San & herbal tea, has been stable. She seems to have better balance, and her dystonia has been really mild. I’d like to see if she can maintain this condition without the help of medication.

I’d like to thank you for helping my daughter getting such a great improvement! I’ll keep you in touch.

Best regards,
L.

-On April 23, 2010

 RE: J….. 9 yrs old with dystonia

Friday, April 23, 2010 6:30 PM

From:”L. M.” l….@hotmail.com
To:
Dr. Fan,
 
My daughter has been taking Liu Jun San capsules and herbal tea for almost two months by now, and she’s got a really big improvement. Her facial tics (eyes and mouth) is like 99% gone. The dystonia on her foot is getting milder. Her foot is not stiff and turn in anymore. She now walks way better and faster. Teachers at her school also notice this big improvement because before walking was really hard for her, they even discussed about getting my daughter on wheelchair to help her go around the school.  But now we don’t think she needs one.
Some teachers were amazed with the result, they asked what I’ve given to my daughter and I gave them your name and your website.  
 
Thank you so much for bringing back my daughter’s confidence. Now she enjoys walking again, and she doesn’t come home from school in tears anymore because walking is so much easier for her now. 
 
I would like to order one course treatment again. I will fax my new credit card to you, please kindly let me know once you receive the fax.  Once again thank you!!
 
Sincerely,
L.

Patient’s e-mail:
— On Tue, 3/23/10, L M wrote:

From: L.M.
Subject: RE: J……, 9 yrs old with dystonia
To: “Arthur Fan”
Date: Tuesday, March 23, 2010, 12:39 PM

Hi Dr Fan,

J…. has been taking the capsules & herbal tea since March 02, 2010. Her facial tics (eyes & mouth) getting much lesser, and she does not complain a lot of headache anymore. As far as the foot there’s a little bit improvement, but I believe there will be so much more improvement as she continue taking the medicine. We are so grateful to find you, because not many people understand dystonia well, even doctors, acupuncturist. I feel so thankful that I could give my daughter natural treatment everyday. And I will still be making effort to take her to your clinic to get acupuncture.

Her neurologist thinks she may be a DTY1 dystonia (something genetic although none in our family has dystonia). In your experience, will it make harder to treat?

Also I will start to use Automatic Medicine Cooker. Will the cooking method and measurement be the same as the one on the paper? Please let me know.

Dr Fan, thank you. May God bless you more and more everyday, so people with dystonia like my daughter always have a hope- to be clinically cured.

I will be contacting you later to order more treatment.

Sincerely,
L.

Dr.Fan’s reply e-mail on 03/23/2010, at 21:00:

Dear L…..,

I am very happy to get your e-mail, and know your daughter has some improvements.

Just keep using the herbs. When she almost finish the herbs, you could let me know, see if we need some adjustments for her.

For automatic cooker, it will save your effort. Not necessary to follow the rule in our instruction. Just putting herbs, adding proper amount of water, turning on electricity, the setting Quick or slow cooking option, after one hour or so, it is done. It will keep warm until you turning off it or automatically turning off at about 3 hours.

For DTY1, or other type of dystonia, we did not have experience to compare the effectiveness, so I could not say anything about that.

Have a good day!

Arthur Yin Fan, PhD,CMD,LAc
McLean Center for Complementary and Alternative Medicine, PLC
8214 Old Courthouse Road, Tysons Square Office Park,
Vienna, VA 22182.
Phone:(703)499-4428; Fax:(703)547-8197
Web: http://www.ChineseMedicineDoctor.US
Blogs: http://www.arthuryinfan.wordpress.com

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02/24/2010

Dr. Fan has recently been busy treating patients with different forms of dystonia from the United States, China and India.

One patient from North Carolina (NC) drove 7.5 hours and is living in a hotel near our office for a short-term for acupuncture treatment.  http://www.youtube.com/watch?v=zJjFopYP

ONE Patient S.P., 72 years old, has had dystonia for 13 years, initially it was cervical dystonia (Spasmodic torticollis), but 3.5 years ago it improved and became Spasmodic Dysphonia (abductor type). Her voice is strained, strangled, choked like, sound hoarse, breathless, anxious or groaning. Also, she has difficult in chewing, but no problem at swallowing.

She had Botox injections for 2 years (each helped about 3 months to some extent). Currently she is using some medications. However, she still finds it very hard to speak. Most of her words could not be understood. So her sister helps her as an interpreter.

To date she has had 3 acupuncture sessions in our office. Both she and her sister feel there has been a great deal of improvement, although she still has a spasmodic voice, her words are basically understandable. We took a second video today and her the difference between initial visit and today. She is very happy with the result.

She plans to treatment for two more days. She plans to come back in near future (after going home to assess the results).

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Written by Dr Helen Hanson, Movement Disorders Unit, King’s College Hospital, London and Dr K Ray Chaudhuri, Movement Disorders Unit, King’s College Hospital, London

Primary dystonias

Generalised dystonia

This is also known as primary torsion dystonia or dystonia musculorum deformans. The usual age of onset is between 5 and 16 years. Parents or teachers may notice an abnormal turning in of the foot, an awkward gait or contractions of many different muscle groups.

The involuntary dystonic movements may progress quickly to involve all the limbs and torso, but the rate of progression usually slows after adolescence.

A genetic basis for generalised dystonia has now been confirmed.

Focal dystonias

Spasmodic torticollis

Torticollis, commonly called wry neck, is the condition of spasm affecting the muscles of the neck, causing the head to assume unnatural postures or turn uncontrollably.

Spasmodic torticollis, also known as cervical dystonia, is the most common of the focal dystonias. There are thought to be 10,000 people in the UK suffering from this condition.. The average age of onset is in the early 40s and more women are affected than men.

The head may tilt (laterocollis) or twist to one side (rotational torticollis), forward (anterocollis) or backward (retrocollis). The movements may be sustained or jerky (myoclonic torticollis). Muscle spasms or pinching nerves in the neck can be very painful. The neck may eventually be held permanently in one position.

Torticollis usually develops gradually. At first, the patient may notice that the head turns during everyday activities. In about a quarter of patients the hand may also develop some tremor, especially if trying to correct the involuntary movement. The tremor is common but not usually disabling and is referred to as an enhanced physiologic tremor.

The severity of torticollis can vary and may be worse if the patient is under stress. Occasionally drinking alcohol can improve the torticollis.

Some sufferers have a history of head or neck injury, but as yet there is no evidence to support the theory that torticollis is directly related to trauma.

Most patients find the condition deteriorates over the first five years, but their symptoms then stabilise. One third of patients progress to a segmental dystonia, usually involving the arm. The symptoms of about 10 per cent may stop spontaneously, but then later recur.

Patients with torticollis often find that their daily lives are affected. Head turning can prevent a proper view of the road when driving, it may become difficult to eat, brush teeth or apply makeup. Many sufferers find embarrassment and anxiety the major handicap.

Blepharospasm

Blepharospasm means the involuntary contraction of the eyelids, leading to uncontrollable blinking and closure of the eyelids.

It affects more women than men and in the UK and it is the second most common focal dystonia with approximately 4000 people affected. In very extreme cases, sufferers are unable to prevent their eyes from clamping shut so that despite normal vision they are functionally blind.

Muscles in the face can also become affected causing facial distortions and grimacing when the patient attempts to open her eyes.

Blepharospasm usually develops gradually. The first sign a sufferer may notice is eye irritation and discomfort, light sensitivity and increased blinking. They may find that the condition worsens when they are tired, under stress or reading. Bright flickering lights, smoke or wind can all irritate the condition making symptoms worse.

Hemifacial spasm

Hemifacial spasm causes muscles on only one side of the face to contract. It affects both men and women and usually develops in middle age. More than 4000 people in the UK are thought to be affected.

Hemifacial spasm develops gradually. Initially the muscles surrounding the eye may be affected by muscle spasms, which continue to spread and affect other muscles on the same side of the face, especially the jaw and mouth. Some patients may experience a clicking sound in the ear on the affected side each time a muscle contracts.

For unknown reasons hemifacial spasm tends to affect the left side of the face more often than the right.

The cause of the spasm may be related to the irritation of the nerve that controls the muscles of facial expression called the facial nerve. This may be due to an abnormally placed blood vessel at the back of the brain, near where the facial nerve arises. So hemifacial spasm may not be truly a dystonia.

Oromandibular dystonia

In this form of dystonia the jaw muscles, lips and tongue are affected causing the jaw to be held open, clamped shut or forced to deviate to one side.

The tongue may be pulled forward, upward, backward or downward.

Sufferers experience problems eating swallowing or speaking. Occasionally, this may be drug induced. Ulceration of the tongue may also occur due to a continuation of dry mouth and tongue twisting.

Orofacial-buccal dystonia

This dystonia is also known as Meiges or Brueghels syndrome. It is a combination of blepharospasm and oromandibular dystonia.

Spasmodic dysphonia

Spasmodic dysphonia (difficulty in voice production) is slightly more common in women than in men and occurs in middle age. The muscles affected are those controlling the vocal cords. Sufferers find that their voice sounds strained and strangled, that it takes a lot of effort to speak and that their voice comes out as tremulous, weak or a breathless whisper.

There are basically two types of spasmodic dysphonia. In the adductor type, speaking causes involuntary excessive muscle contraction of the muscles that bring the vocal cords together. This causes a strained, strangled, choked voice quality, often with abrupt initiation and termination of voicing, resulting in a broken speech pattern. The patient may sound hoarse, breathless, anxious or groaning.

In the abductor type, there is an overcontraction of the muscles that separate the vocal cords, resulting in a choppy and breathy whispering voice pattern.

Spasmodic dysphonia may follow an infection of the respiratory tract, injury to the larynx or a period of excess voice use.

Most patients find that they are able to use their voices normally in some situations. Patients with the adductor type may be able to laugh, whisper or sing normally. Improved speech is noted during emotional or physiological states for example joy, anger or following yawning. Shouting or stress usually makes the condition worse.

Writer’s cramp

In this type of dystonia the muscles of the hand and forearm are affected. Contraction or extension of the hand and finger muscles prevents activity or causes an exaggerated posture.

The patient complains of tension and discomfort. They might start to grip the pen too tightly and the script becomes slow and untidy. After a few words the patient is forced to stop and rest. The contraction disappears on stopping writing.

Occasionally the hand dystonia may also be associated with a tremor known as dystonic tremor. Sometimes a primary writing tremor may be mistaken as writing cramp.

Patients often employ trick manoeuvres to overcome the cramp. Some support their writing hand with their opposite arm, use thick nibbed pens, alter their grip or hold the pen in a closed fist. Unfortunately the cramp may arise in the other hand. Patients also find that they begin to have problems with holding other utensils such as forks and knives. Occasionally, the dystonia may be preceded by trauma to the limb.

There are other focal dystonias that are associated with a particular activity or occupation. Examples include typist’s cramp, pianist’s cramp and golfer’s cramp.

Adult-onset primary dystonia

This is a rare subtype of focal dystonia. The symptoms remain localised to the trunk of the body, but may spread to involve the neck muscles. The dystonia does not spread to the leg. Unlike other forms of focal dystonia it is more common in men than women.

The twisting trunk movements have been likened to the Leaning Tower of Pisa, and the term Pisa syndrome is occasionally applied to these dystonias.

‘Dystonia-plus’ syndromes

Dopamine, (often called ‘dopa’ which is in fact an intermediate chemical in dopamine’s production) is a chemical messenger widely used in the nervous system in passing nerve impulses between nerve cells (neurotransmission). Dopa-responsive dystonia is an important form that can be successfully treated with drugs such as levodopa (eg Madopar, Sinemet). Typically it begins in childhood or adolescence and leads to progressive difficulty in walking and in some cases spasticity (limb stiffness). The symptoms may fluctuate during the day from relative mobility in the morning to increasingly worse disability in the afternoon, evening and after exercise.

This is an important condition to recognise as treatment can result in dramatic improvement in symptoms.

Myoclonic dystonia is a rare type combining dystonia and sudden muscular spasms (myoclonus). The onset is in adolescence or early adult life. It mainly affects the arms and body. These patients can be very sensitive to treatment with alcohol and a genetic basis has been suggested.

Secondary dystonias

Secondary dystonias are often accompanied by other neurological problems. They begin suddenly at rest and are associated with different hereditary and environmental causes. Environmental causes include head trauma, stroke, a tumour, multiple sclerosis, infections in the brain, injury to the spinal cord, or after chemotherapy, drugs or toxins that affect the basal ganglia, thalamus or brain stem.

They may be associated with other hereditary neurological syndromes. Dystonia may be the first sign in a patient with Huntington’s disease, and is secondary to many other neurological diseases. These include Parkinson’s disease, Wilson’s disease and Ataxia telangiectasia. Examples of metabolic disorders causing secondary dystonia are Lesch-Nehan syndrome, Niemann-Pick disease and Leigh’s disease. All of these causes are rare.

What drugs can cause dystonia?

Certain drugs have been implicated in causing dystonic reactions or dystonia. This form of dystonia is referred to as secondary or drug induced dystonia. Some drugs may not cause dystonia but may aggravate the pre-existing disorder. Patients should avoid these drugs.

The list of drugs causing drug induced dystonic reactions is long but includes:

In general, alcohol does not have an adverse effect on dystonia but it is rarely seen to hasten it. Alcohol may also help dystonia, particularly forms of myoclonic dystonia. People who chronically abuse alcohol can get a series of involuntary movements or tremors not related to dystonia. Excess alcohol intake is not advised.

Is dystonia hereditary?

It has long been thought that there is a genetic or hereditary link to dystonia, as relatives of patients suffering from dystonia often also have some kind of tremor or dystonia and this link has now been identified in some types of dystonia.

Childhood dystonia (early-onset primary torsion dystonia or dystonia musculorum deformans) is often inherited through one or more affected/mutated genes.

If a parent has this type of dystonia, there is a 50 per cent chance of passing the gene to their children. The gene is on chromosome 9 and known as DYT1. (This mutation has been observed mainly in Ashkenazi Jews.) However, even if the child inherits the gene, they may not necessarily develop dystonia. This is known as reduced penetrance. In the UK about 40 per cent of people with the affected gene develop dystonia.

Research has shown that the gene DYT1 codes for a newly recognised protein called Torsin A. Its function is unknown. However, large amounts are concentrated in an area of the basal ganglia called the substantia nigra pars compacta, suggesting it has a role in dopamine neurotransmission.

Late-onset primary torsion dystonia or focal dystonia is inherited in a more complex manner than the early-onset dystonia. Genes known as DYT6 on chromosome 8 and DYT7 on chromosome 18 may be involved. These genes also have reduced penetrance so only about 12 per cent of people with the affected gene develop the dystonia. DYT6 has been found in people whose neck or head muscles are affected causing problems with neck, speech or facial muscles. DYT7 has been found in those mainly affected with myoclonic torticollis.

Dopa-responsive dystonia also has a genetic basis. Many patients have a mutation in a gene known as GCHI (GTP cyclohydroxylase) on chromosome 14. There is a 50 per cent chance of parents passing on the gene, although with reduced penetrance. However, it occurs more in women. Mutations in this gene cause abnormal production of a chemical called tetrahydrobiopterin, needed to produce the neurotransmitter dopamine. The drug levodopa is helpful in treating this form of dystonia as it increases dopamine levels in the brain.

Myoclonic dystonia also has a genetic component. A mutation in a receptor for the neurotransmitter dopamine has been found on chromosome 11 or 18.

See more, you could visit http://www.netdoctor.co.uk/diseases/facts/dystonia.htm

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Dear Dr. Fan, 

 I have seen some of your work with dystonia and Chinese Medicine on line.  My wife suffers from dystonia (mostly face and neck).  We are in Singapore presently and wonder if you could refer us to someone here in Singapore who might be able to follow your efforts and be of assistance to us.

Reply by Dr. Arthur Fan (e-mail) 

Dear Mr. A.T. 

I am sorry; I could not refer any acupuncturist or CMD I don’t know in Singapore.

If you like, the alternative way is you see a Chinese medicine doctor and give me your information, such as the history, tongue/pulse information, appetite, bowel movement information, etc.

Then I could mail you the herbs, pills, etc..

Arthur Yin Fan, PhD,CMD,LAc

Asking(e-mail)

Dear Dr. Fan, 

Thank you so much for your response.  Is there a clinic or hospital in Singapore that practices the same or similar medicine as you do that you would suggest we consider going to?  I know there are some possibilities in Chinatown in Singapore, but I don’t know if there is anyone that would have the same focus or experience that you might. 

Thanks, 

A.T.

Reply by Dr. Arthur Fan (e-mail) 

Hi, Mr. A. T.

In Chinese medicine, there are general practice and specialty practice. You may see someone who specialized in Chinese medicine neurology.

Sometime, the general practice may works also.

Arthur Yin Fan, PhD, CMD, LAc

Asking 

Dear Dr. Fan, 

Thank you for your past emails.  We appreciate them. 

My wife and I have relocated to the Delhi, India area, so we don’t have the current benefit of TCM in Singapore.  However, in a couple of days I plan to be in Kuala Lumpur, Malaysia and there want to secure a supply of Peony Root, Papaya, and Tian Ma.  I think I can obtain them. 

Can you tell us how these herbs should be used?  We don’t know anything about how to use them.  My wife is not very heavy–about 120 lbs., perhaps.  Also, she is still using some western medications (such as Amantadine, Valium (as a muscle relaxant), and I think also Pasatane) which we hope create no conflict.  (That was our concern in Singapore.) 

Also, if in Delhi we don’t have any regular access to acupuncture, can the herbs work on dystonia by themselves? 

We appreciate your advice.

Thanks.

Kind regards,

A.T.

Dr. Fan said: please don’t use herbs by yourself. Herbology is a specialty.

***NOTE: This patient came to Virginia to see me in last week.—-Dr. Fan notes.

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I have written and told dystonia patients: dystonia is only an outside manifestation (symptoms and signs) of inner side brain injury or degeneration / disorder at the basal ganglion area.  In theory, for structural brain damage, there is no way to “cure” this problem.  In conventional medicine, there are several drugs (including Botox) which could diminish the symptoms and surgery would try to injure certain normal areas to reach the balance. 

However, if you using Chinese medicine, after a long-term treatment, say more than half year, we may reach the balance and “clinically Cure” the dystonia (which means controlled very well).

We have had several cases of dystonia in China and in USA, after continuous treatments with acupuncture and Chinese herbal tea, where the patients’ dystonia symptoms are very, very occasionally obscure. You could basically could stop the acupuncture and Chinese herbology. But they do need maintenance, say acupuncture once every week or two, otherwise the symptoms returned (they should be mild treatments).

For the short-term acupuncture or Chinese herbal treatments, patients may get temporary improvements, but this may not create a stable cure.

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