Highlights for dystonia • 2025 MDS Congress

Dystonia is a movement disorder characterized by sustained or intermittent abnormal movements and postures, typically patterned and repetitive, often worsened by voluntary action; the Movement Disorder Society recently updated its two-axis classification system to include phenomenology, temporal dimensions (adding onset), body distribution across seven standardized regions, and pathogenic mechanisms, reflecting modern understanding that dystonia is a network disorder involving multiple brain regions including the basal ganglia, cerebellum, thalamus, and sensory-motor cortex rather than a single lesion; diagnostic challenges persist due to misidentification as orthopedic or psychiatric conditions, but can be improved through standardized classification, validated clinical scales, and high-quality video documentation; neurodegeneration with brain iron accumulation (NBIA) disorders, such as pantothenate kinase-associated neurodegeneration (PKAN), represent a heterogeneous group where iron accumulation may be an epiphenomenon rather than causal, and while iron chelation therapy reduces brain iron on MRI, clinical benefits remain limited, though gene therapy trials are now advancing for these monogenic forms.