Preface

Dystonia is considered one of the most controversial diseases when it comes to diagnosis, clas‐ sification, and evidence-based lines of management. Each case is different, and it can be quite challenging to get these movements under control.

Dystonia is a wide-spectrum disorder that affects all age groups. Management of dystonia is challenging, and specific goals should be identified. Dystonia is considered one of the most disabling conditions in the pediatric age group, which may remain until adulthood. Treatment is usually unsatisfactory, and patients will show limited response to pharmacotherapy.

Current treatment aims to help decrease the frequency of abnormal involuntary movements, improve posturing, and prevent the subsequent development of contractures. Many modalities are discussed in the management part, including pharmacotherapy, oral medications, cannabis, botulinum toxin injection, and surgical interventions like intrathecal baclofen pump and deep brain stimulation for patients with generalized dystonia who failed oral pharmacotherapies.

Bearing in mind the new classification, where the term "primary" is no longer recommended, and that in the majority of cases it resembles the new and more precise term "isolated", both terms are used in this chapter. To be correct when providing information from the studies cit‐ ed, it should be understood that time and effort are needed to replace completely the old ter‐ minology with the new one.

A full chapter was assigned to non-motor comorbidities encountered with dystonia, including sleep, psychiatric disorders, cognition, as well as pain and sensory symptoms, their pathophy‐ siological and biochemical mechanisms, relations with symptomatic treating strategies for ab‐ normal movements, and specific treatment for non-motor signs.

The book contains four chapters that discuss dystonia from new perspectives. The chapters have been written by different specialists from many countries. Dystonia may result from ei‐ ther diffuse or localized pathology of the cerebral cortex, brain stem, or spinal cord. Manage‐ ment of dystonia is challenging, and specific goals should be identified.

Meige's syndrome, or "oromandibular dystonia," may be misdiagnosed as *temporomandibular joint* or psychogenic disorder, which will alter management and delay proper treatment. Dysto‐ nia with non-motor disorders includes sleep, cognitive, pain, sensory, and psychiatric disorders, and their pathophysiological and biochemical mechanisms and specific treatment are discussed.

This book will be of interest to GPs, neurologists, family physicians, and internal medicine specialists.

## **Professor Tamer Rizk, MD, FRCPCH, ProfDip HMPDip (UK)**

Department of Pediatrics Saint John Regional Hospital New Brunswick, Canada

**Section 1**

**Introduction**

**Section 1**
