When should I consider referring a patient with dystonia to a specialist for further evaluation?

Consider referring an adult patient with suspected dystonia to a specialist for further evaluation when they present with persistent abnormalities of posture, such as cervical dystonia characterized by abnormal head or neck posture, with or without head tremor, especially if symptoms improve when the patient touches their chin. Also refer adults with dystonia affecting other body parts (e.g., writer's cramp or in-turned foot posture) for assessment and possible botulinum toxin treatment. In cases where handwriting difficulties are specific to the task and no other abnormalities are found, consider referral for possible focal dystonia. Be aware that dystonia can be a side effect of antipsychotic and antiemetic medications, which may warrant specialist assessment.