Symptoms & Classifications

In May 2025, an updated definition and classification of dystonia was published in Movement Disorders. This update builds on the original 2013 consensus publication and incorporates important scientific advances made over the past decade, particularly in areas like genetics and cell biology.

This updated consensus is designed to help doctors better recognize, diagnose, and treat dystonia, so patients can get more accurate care and support. It also helps ensure that people all over the world are using the same concepts and terminology when talking about and studying this condition.

Formal Definition of Dystonia

Dystonia is defined as “a movement disorder characterized by sustained or intermittent abnormal movements, postures, or both. Dystonic movements and postures are typically patterned and repetitive and may be tremulous or jerky. They are often initiated or worsened by voluntary action and frequently associated with overflow movements.”

How Is Dystonia Classified?

The system uses two main “axes” to define and classify dystonia:

Axis I: Clinical Characteristics

These are descriptors that neurologists use to classify dystonia and guide testing during diagnosis. They include:

1. Age of Onset of Symptoms– can range from infancy to late adulthood
2. Family History– whether dystonia is likely genetic or appears sporadically
3. Body Areas Affected– e.g., just the neck (focal), or several body regions (generalized)
4. Timing and Course– how and when symptoms start, and whether they change or stay the same over time
5. Movement Features– how the dystonia occurs: Does it happen with movement? Is it tremor-like or jerky? Are there ways to ease it?
6. Other Symptoms– whether dystonia is the only issue or occurs alongside other movement disorders or neurological symptoms

Axis II: Causes and Biological Mechanisms This axis focuses on what causes dystonia and how symptoms are expressed:

1. Genetic Factors– recognizing the genetic forms, whether inherited or not
2. Acquired Causes– like certain medications, toxins, or injuries
3. Brain Imaging Clues– identifying areas of the brain that might be damaged
4. Biological Processes– such as developmental factors, cellular or metabolic pathways, or immune reactions

What’s New and Improved in the 2025 Publication?

• More precise descriptions of symptoms and their timing
• New terms that reflect novel developments in genetics and molecular biology
• A clearer guide to help doctors connect symptoms with possible causes
• Useful for both everyday medical care and future research and treatment development

Impact of the 2025 Definition and Classification

This new system recognizes that dystonia can affect people in many very different ways and originate from a variety of genetic and non-genetic causes. It offers a more detailed and clearer way to understand and classify dystonia. Ultimately, it is designed to help neurologists make better diagnoses and researchers explore more targeted treatments.

Source: Albanese, A., Bhatia, K.P., Fung, V.S.C., Hallett, M., Jankovic, J., Klein, C., Krauss, J.K., Lang, A.E., Mink, J.W., Pandey, S., Teller, J.K., Tijssen, M.A.J., Vidailhet, M. and Jinnah, H.A. (2025), Definition and Classification of Dystonia. MovDisord. https://doi.org/10.1002/mds.30220