Cervical Dystonia

Cervical dystonia, also called spasmodic torticollis, is a painful condition in which your neck muscles contract involuntarily, causing your head to twist to one side. Cervical dystonia can also cause your head to uncontrollably tilt forward or back.

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What is it?

Cervical dystonia, also called spasmodic torticollis, is a painful condition in which your neck muscles contract involuntarily, causing your head to twist to one side. Cervical dystonia can also cause your head to uncontrollably tilt forward or back.

A rare disorder that can occur at any age, even infancy, cervical dystonia most often occurs in middle-aged women. Symptoms generally begin gradually and then reach a point where they don't get any worse.

There is no cure for cervical dystonia, but the disorder sometimes resolves on its own. Injecting botulinum toxin into the affected muscles often reduces the signs and symptoms of cervical dystonia. Rarely, surgery may be necessary.

Symptoms

Twisted neck

The muscle contractions involved in cervical dystonia can cause your head to twist in a variety of directions, including:

  • Chin toward shoulder
  • Ear toward shoulder
  • Chin straight up
  • Chin straight down

The most common type of twisting associated with cervical dystonia is when your chin is pulled toward your shoulder. Some people experience a combination of abnormal head postures. A jerking motion of the head also may occur.

Pain

At least two-thirds of the people who have cervical dystonia also experience neck pain that can radiate into the shoulders. The disorder also can cause severe headaches. In some people, the pain from cervical dystonia can be exhausting and disabling.

Other

  • Tremor. Cervical dystonia may also cause tremors in your arm or hand.
  • Shoulder elevation. The disorder may also cause the shoulder on your affected side to pull up toward your ear.

Causes

Researchers believe that the signs and symptoms of cervical dystonia result from a defect in the brain's ability to process chemical messages that allow brain cells to communicate with each other.

In most cases of cervical dystonia, doctors don't know why some people develop the disorder and others don't. Some cases, however, appear to be linked to:

  • Head, neck or shoulder injuries
  • Strokes
  • Tumors in the brain or spinal cord
  • Drugs, including some antipsychotic, anti-nausea and antidepressant agents
  • Toxins, such as heavy metals and carbon monoxide

Risk factors

Risk factors for cervical dystonia include:

  • Age. While the disorder can occur in people of any age, even infants, it most commonly begins between the ages of 40 and 60.
  • Sex. Compared with men, women are nearly twice as likely to develop cervical dystonia.
  • Family history. If a close family member has cervical dystonia or another movement disorder, you are at higher risk of developing the disorder.

Complications

Cervical dystonia can lead to:

  • Nerve damage. The sustained muscle contractions associated with cervical dystonia can cause permanent damage to compressed nerves. Symptoms include pain, numbness and tingling.
  • Involvement of other body parts. Some people who start out with cervical dystonia eventually develop similar symptoms in the face, jaw, arm or trunk.
  • Depression. The disability and pain that can be caused by cervical dystonia may result in depression.

Diagnosis

While the physical examination alone can often confirm a diagnosis of cervical dystonia, it's important to determine if there are underlying conditions causing your signs and symptoms. Tests may include:

  • Blood or urine tests. These may reveal the presence of toxins.
  • Magnetic resonance imaging (MRI). This type of imaging test may be used to identify and visualize tumors or evidence of stroke.
  • Electromyography (EMG). This test measures the electrical activity of muscles. EMG helps evaluate and diagnose muscle and nerve disorders and can help confirm whether you have cervical dystonia or another condition.

Treatments and drugs

There is no cure for cervical dystonia. Treatment focuses on relieving the signs and symptoms.

Medications

People who have cervical dystonia often must use a combination of medications to reduce their signs and symptoms.

  • Botulinum toxin. This paralyzing agent, often used to smooth facial wrinkles, comes in two varieties — type A (Botox) and type B (Myobloc) — that can be injected directly into the neck muscles affected by cervical dystonia. Most people with cervical dystonia see an immediate improvement with this treatment, which usually must be repeated every three to four months.
  • Parkinson's drugs. Medications used to combat the tremors associated with Parkinson's disease, including trihexyphenidyl and benztropine, may be used in combination with botulinum toxin injections.
  • Muscle relaxants. These types of drugs also reduce anxiety, so they are especially helpful with symptoms that are worsened by stress. Examples include diazepam (Valium), lorazepam (Ativan), clonazepam (Rivotril) and baclofen (Lioresal).

Therapy

Stretching and strengthening exercises to improve posture can help reduce pain and may prolong the effect of botulinum toxin injections.

Surgical and other procedures

If less invasive treatments don't help, your doctor may suggest surgery.

Deep brain stimulation. This surgical procedure inserts a thin, insulated wire into the brain through a small hole cut into the skull. The tip of this electrode is placed in the portion of the brain that controls neck movement. The electrode is connected, via a wire that passes under the skin, to a small battery pack in your chest. The battery pack is about the size of a pocket watch, and it sends electrical pulses to the electrode to interrupt the nerve signals making your head twist.

Cutting muscles or nerves. Surgery to cut the nerves or muscles responsible for the contorted posture associated with cervical dystonia can be performed to help those who no longer get benefit from botulinum toxin or medications.

Lifestyle remedies

Cervical dystonia has no cure, but you can do a number of things to minimize its effects:

  • Reduce stress. Avoiding situations that cause stress or anxiety is important because stress tends to make your signs and symptoms worse.
  • Get your rest. Signs often disappear during sleep, so get plenty of rest. You may find relief by taking short breaks during your day to lie on your back and relax.
  • Try touching. Sensory tricks, such as touching the opposite side of your face or the back of your head, may cause spasms to stop temporarily. Different sensory tricks work for different people, and if you find one that works, it usually will continue to work for you.

Alternative medicine

In addition to your regular treatment, techniques such as massage therapy, biofeedback and relaxation techniques may provide additional relief from your symptoms.

Coping and support

Remember that you're not alone. A number of organizations and support groups are dedicated to providing information and support for you and your family — whether you have the disorder or you have a friend or family member who does. Your doctor may be able to suggest support groups available in your area, or there are a number of good sites on the Internet with information about local support groups.

Treatment & Management Strategies

If you would like to know the latest treatment and management strategies, using conventional and scientifically backed complementary medicine and therapies, plus an assortment of helpful tips, hints and lifestyle remedies which will improve your overall quality of life, then call into our pharmacy and we'll be delighted to help.

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