PREFINAL EXAMINATION OSCE LEARNING POINTS

My case for today was a case of acute cervical dystonia. Was a quite interesting case which I saw in the recent times. 
             Different diagnosis were considered for it like
  Tetanus
  Focal seizures
  Drug induced dystonia
   
Now my learning points were:
    - With so many differentials in mind, how to land up in a particular diagnosis
   - Why drugs cause dystonia in a few and doesn't in the other? 

     Let's dig deep to know how🙂

Focal dystonia

Focal dystonia is limited to one area of the body and can affect the neck (cervical dystonia or spasmodic torticollis), eyes (blepharospasm), jaw/mouth/lower face (oromandibular dystonia), vocal cords (laryngeal dystonia) or arms/legs (limb dystonia). Other less common types of focal dystonias can cause unusual stretching, bending or twisting of the trunk (truncal dystonia) or sustained contractions and involuntary, writhing movements of the abdominal wall (abdominal wall dystonia).

Symptoms
Dystonia affects different people in different ways. 

Begin in a single area, such as your leg, neck or arm. Focal dystonia that begins after age 21 usually starts in the neck, arm or face. It tends to remain focal or become segmental.
Occur during a specific action, such as writing by hand.
Worsen with stress, fatigue or anxiety.
Become more noticeable over time.
Areas of the body that can be affected include:
Neck (cervical dystonia). Contractions cause your head to twist and turn to one side, or pull forward or backward, sometimes causing pain.

****************************************

What is drug induced dystonia?

Dystonia may occur from administration of dopaminergic  agents, lithium ,SSRIs,carbamazepine, and metoclopromaide.
The five characteristics of the drug-induced dystonic reactions are oculogyric crisis, torticollic crisis, buccolingual crisis, opisthotonic crisis, and tortipelvic and gait crisis.
Tardive dystonia caused by intake of certain drugs. Most commonly, these are antipsychotics or anti nausea drugs which block the dopamine receptors in the brain. Dopamine is found in the basal ganglia and is responsible for normal movement. It has been hypothesized that these drugs can activate an underlying susceptibility in certain individuals.


Here comes the question of discussion for me today... 
       WHY ONLY CERTAIN PEOPLE GET DRUG INDUCED DYSTONIAS WHILE OTHERS USING THE SAME DRUG DONT? 

According to a medical journal, 
         Risk factors for a patient to develop drug induced dystonia include
   - male sex
- cocaine abuse
- previous history of acute dystonia ( which our patient had 10 yrs ago) 

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