In most cases the cause for dystonia is unknown. In a small number of patients, trauma precedes the onset of the dystonia. Significant head trauma is a well-recognized precipitating factor in dystonia.

It has become increasingly recognized that peripheral trauma can also result in dystonia. Peripheral trauma is defined as trauma outside the central nervous system. The trauma is generally less severe compared to CPD and more controversial as a causative factor in the development of the dystonia. Because of potential recall bias and legal ramifications, specific criteria have been proposed for attributing a case of dystonia to peripheral trauma. The injury must be severe enough to cause local symptoms for at least 2 weeks. The onset of the dystonia should be within days up to 1 year after the injury, and the onset of the movement disorder must be anatomically related to the site of the injury.  

The objective of this review was to describe both forms of post-traumatic dystonia, including pathophysiology and treatment, discuss the relationship between complex regional pain syndrome (CRPS) and peripheral post-traumatic dystonia (PPD), and compare the two disorders to each other and to idiopathic dystonia.

Although uncommon, trauma may be responsible for the development of dystonia. Central trauma produces lesions on MRI with a delayed onset of dystonia. The dystonia appears to follow resolution of hemiparesis, begins distally, and can spread over time. The most common form of CPD is hemidystonia. The dystonia rarely remits and can be treated with botulinum toxin and DBS. Treatment response tends to be variable. Peripheral trauma is a controversial cause of dystonia in a small subset of patients. Pain appears to be greater in PPD compared to idiopathic dystonia. Focal dystonia is the most common form and CRPS may develop in a small percentage of patients. Treatment with botulinum toxin is variable with lack of robust improvement often seen in idiopathic dystonia. However, a multimodal approach involving physical therapy, occupational therapy, and psychological therapy, may be more effective. In summary, both central and peripheral traumas produce characteristic patterns of dystonia and should be considered in each presenting case of dystonia.

In summary, both central and peripheral traumas produce characteristic patterns of dystonia and should be considered in each presenting case of dystonia.

  

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