Why Dystonia Fluctuates: Stress Modulates Dystonia

In my work with patients and research, I’ve seen how stress can intensify dystonic symptoms. Many of my patients experience that when calm and in familiar environments, they often have more control over their movements, but under stress, their symptoms may worsen.

Although dystonia arises from a complex combination of genetic predispositions and environmental influences, stress plays a powerful role in intensifying its symptoms, making them more frequent and severe. Finding effective ways to relax and calm your nervous system can be paramount in managing the condition more efficiently.

How Stress May Affect Dystonia

Many of the patients I work with experience fluctuations in their dystonia symptoms, often based on how stressed or relaxed they feel. In times of low stress, they can often manage their symptoms and control their movements more effectively. However, during periods of heightened stress, anxiety, or exhaustion, their symptoms become more pronounced.

Years ago, I developed a theory suggesting that patients with Dystonia could experience both symptomatic and asymptomatic phases, where their symptoms could effectively switch on and off. I proposed—what is now considered a formal theory of Dystonia—that stress triggers lapses in descending inhibition in these patients. In stressful situations, the brain’s inhibitory signals weaken, causing the spinal cord’s motor circuits to become overactive. This leads to abnormal, involuntary muscle contractions and reduced pain modulation. This theory helps explain why some patients feel more coordinated and in control when calm, but see their symptoms worsen under stress.

One of the key reasons for this fluctuation is the role of descending inhibition in motor control. Descending inhibition refers to the brain’s ability to send signals down to the spinal cord to regulate and suppress excessive muscle activity. This is crucial for ensuring smooth and controlled movements.

Under stress, descending inhibition can be weakened, leading to the overactivity of the spinal cord’s intrinsic motor circuits. This may cause co-contraction of opposing muscle groups, resulting in the involuntary postures and movements that are characteristic of dystonia. Essentially, the brain’s ability to keep the spinal cord’s reflexes in check is compromised under stress, allowing dystonic symptoms to emerge or worsen.

Key Brain Regions Involved in Descending Inhibition

Several areas of the brain are responsible for controlling descending inhibition, including the cerebellum, basal ganglia, and motor cortex. The cerebellum, in particular, plays a vital role in maintaining coordinated and controlled movement. It sends inhibitory signals through Purkinje cells to the deep cerebellar nuclei (DCN), which in turn control motor outputs to the spinal cord.

Mechanisms of Stress-Induced Lapses in Descending Inhibition

Stress can cause the breakdown of descending inhibition through several mechanisms. Here are some possible explanations for why dystonic symptoms worsen under stress:

1. Increased Neural Excitability: Stress activates the body’s arousal systems, including the hypothalamic-pituitary-adrenal (HPA) axis, leading to increased excitability in the brain. In dystonia, this heightened neural activity can overwhelm the brain’s ability to send inhibitory signals to the spinal cord, resulting in overactivity of spinal motor circuits.
2. Reduced GABAergic Inhibition: GABA (gamma-aminobutyric acid) is the main inhibitory neurotransmitter in the brain, playing a key role in descending inhibition. Under stress, GABA signaling can be impaired, which reduces the brain’s ability to suppress excessive movement, contributing to the onset of dystonic symptoms.
3. Disrupted Sensory-Motor Integration: The brain relies on sensory feedback to control movement. Stress can distort how sensory inputs are processed, which in turn affects motor outputs. In dystonia, this disrupted processing can result in inappropriate or excessive motor responses, as the brain is unable to accurately modulate the signals it sends to the spinal cord.
4. Dysregulation of Central Pattern Generators (CPGs): These are networks of neurons in the spinal cord that generate rhythmic, coordinated motor patterns like walking. Stress may lead to dysregulation of these networks, resulting in abnormal motor outputs that manifest as dystonic movements.

How Neuroplasticity Training Can Help

Over the years, I’ve seen how neuroplasticity training can be highly effective in helping reduce the severity of dystonic symptoms. By retraining the brain’s motor circuits, patients can learn to improve their motor control and reduce their brain’s sensitivity to stress.

Through a combination of physical exercises, sensory stimulation, and motor training, neuroplasticity techniques help the brain build new pathways that better regulate movement and suppress excessive muscle contractions. This process can lead to stronger descending inhibition, reducing the intensity and frequency of dystonic episodes. In time, patients often find that they can cope with stressful situations more effectively and experience fewer dystonic symptoms as a result.

Conclusion

Dystonia is a complex movement disorder that fluctuates in response to stress, illness, exhaustion, and other factors. The lapses in descending inhibition caused by stress can allow the spinal cord’s motor circuits to become overactive, leading to involuntary movements. Understanding these mechanisms is key to managing the condition, and neuroplasticity training offers a promising approach to improving motor control and reducing the impact of stress on dystonic symptoms. By retraining the brain, patients can gradually regain better control over their movements and reduce the intensity of dystonic episodes, even in stressful situations.