Could Dystonia ever be biomechanical ?

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Hi,

Apologies in advance for the vagueness and open-endness/ hypothetical nature of this question.


If you had an extremely active, previously healthy 12 year old boy who has the perfect storm of :

Very tight posterior compartment musculature, gastrocs/soleus hamstrings ++, sufficient to make the child a toe walker (so his sagittal plane mechanics is all working against him) then combine this with a massive growth spurt in height over the past 6 months.

This is the hypothetical bit.

Could this create enough longitunal tissue stress on his neurology to effctively disable him , rendering him unable to ambulate, and have hypertonia on one side of his body.

I appreciate this is really a neurological question but I wonder what peoples thought are on this,or if anyone has any personal experience of anything similar. I have read about the plasticity of the brain and how sleep is like medicine with dystonias, but I haven't been able to find any info about whether actual tissue stress on nerves could cause this at a time of rapid growth.

Sincerely

Chris Schafer BSc(Hons)
MSK Podiatrist

 

My short podiatrist's overview of the field of Neurology: Neurology uses the wiring diagram and knowledge of the physiology of nerves to explain what happens when something goes wrong. (Different spinal tracts, different peripheral nerves and things seen with upper versus lower motor neuron lesions.) You need to explain why one side is different than the other. How could abnormal mechanics affect nerves to just one side of the body? Which nerve/ part of the spinal cord would be affected by these mechanics? Is the mechanical affect causing compression on the nerve and with compression of a nerve would get reduced nerve output. Look up the different effects of upper versus lower motor neuron lesions.

It sounds like a serious problem with an extremely low probability that it would be helped with heel lifts.

 

Thanks for that Dr Fuller, much appreciate the direction I need to approach this from. I do not have hands on access to this patient as they are overseas and complicated by the fact that they are a colleague's son.

Apologies agian for another hypothetetical question:

From my own experience of Msk, would I be wrong in thinking that the asymmetrical pattern could ? be the result of that growth spurt being combined with joint hypermobilty/ a scoliosis scenario where the spine has veered off on a tangent overcompressing one side moreso rending muscle weakness unilaterally?

Sincerely

Chris Schafer BSc(Hons)
Msk Podiatrist

 

Unilateral weakness is not something to be diagnosed over the phone, or the internet. There are many possible causes, some more serious than a scoliosis. If it were my kid, I'd be asking for brain and spinal cord imaging.
That said, we can think through the academic discussion. Theoretically a scoliosis could cause compression of nerve roots on one side and not the other. One would assume that this would effect both motor and sensory nerves. If only some nerve roots are compressed there would be a different distribution of motor or sensory loss, depending on which nerve roots were compressed. If there is motor loss and no sensory loss, one should put a lower percentage probability that a scoliosis is causing the problem. I don't really know if nerve root compression would affect motor conduction before it would affect sensory nerve conduction. Regardless, you should not just stop at scoliosis causes muscle weakness. You should go a little further and figure out why a scoliosis would cause weakness. Imaging could then confirm whether your theory was correct, or not.

 

Thank you again Dr Fuller, You see the kid is having nerve conduction tests, has had genetic testing for genetic aquired Dystonias, they have had MRI (and I can summarise the report which I have been sent)

The thing is IF all of the above were to come back as 'no significant finding' and there is no genetic family history of dystonias, then does that take me back to the drawing board in keeping a biomechanical cause on the table??
I should also mention that this process so far has taken 6 months to get to this point, through apparently the best people in Chicago through private health care, and when a 2nd opinion was asked for, you may be shocked to hear that a date of November 2023 was the earliest. This was likely due to the demand on these specialists (post pandemic) but you may appreciate I am just trying to help in any way I can, due to their frustrations and the onset of the child's lack of mobility. Thank you again, and I hope you can appreciate why I am just trying to explore all of the causes.

(If from an educational basis there is significant value in anonymizing any significant findings then if appropriate, I can do so?)

Many thanks


Chris Schafer BSc(Hons)
Msk podiatrist

 

For anybody that wants to delve into the Dystonias, I found a paper called Defining research priorities in Dystonia by C Lungu on NIH