Cervical dystonia, which is also known as spasmodic torticollis, is a condition that is characterized by uncontrollable contractions of the muscles in the neck that control the position of the head.
These contractions cause abnormal head postures in which the head is turned to one side or tilted forward or backward. In some situations the shoulder is also pulled up. These twisting and turning movements occur involuntarily or when the person is stressed and they are usually painful.
Other symptoms of cervical dystonia include jerking motions of the head, headaches and neck pain that can radiate to the shoulders.
Though the symptoms of cervical dystonia can begin at any age, they most often start between the ages of 40 and 70. Other risk factors associated with developing this condition include being a woman and having a close family member with this or any other type of dystonia.
The exact cause of cervical dystonia is not known. However, researchers believe that it develops from a problem in the basal ganglia which is the part of the brain that controls movement. Head, neck and shoulder injuries are also linked to this condition. Medications like some antipsychotics and anti-nausea drugs have also been known to trigger torticollis in some people.
Diagnostic tests done for cervical dystonia include electromyography (EMG) in which the electrical activity of the muscles in measured. Magnetic resonance imaging (MRI) is also done to rule out tumors and strokes.
There is no cure for cervical dystonia but around 10 percent of patients experience spontaneous remission. This remission however may not be permanent.
The treatment for torticollis therefore aims at reducing the symptoms and it includes injecting botulinum toxin type A which is commonly known as Botox. This medication which is produced by the bacteria Clostridia botulinum, is injected into the neck muscles to paralyze them since it blocks the release of the neurotransmitter or signaling chemical known as acetylcholine which causes muscle contractions. By preventing contractions, botox improves the abnormal postures. Repeat injections are required since the effects usually last for a just a few months.
Muscle relaxants like diazepam (Valium), lorazepam (Ativan) and clonazepam (Klonopin) are also used to reduce the spasms. Side effects of these medications include sedation and imbalance.
Pain medications may be used by those with severe pain. Examples include non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen.
Supportive therapies for cervical torticollis include physical therapy exercises that improve the strength and flexibility of the neck muscles. Neck braces are also worn to support the muscles. Relaxation techniques are taught for those whose condition is aggravated by stress.
Deep brain stimulation (DBS) is a surgical procedure that is used to treat persons with severe cervical dystonia. In this operation the surgeon places electrodes in the brain which are connected to a battery operated pulse generator known as a neurostimulator that is implanted in the chest. This neurostimulator sends electrical impulses to the areas in the brain that control movement and stops the abnormal muscle movements.
Selective denervation procedure is another surgical option for patients with severe cervical torticollis. In this procedure the surgeon cuts the nerves that control the muscles that are responsible for the abnormal head postures.
The treatment of cervical dystonia is important because even though the symptoms are usually mild and unnoticeable in the early stages, within a few months or years they become more severe and may even spread to affect the shoulder and face. Person with this condition may even develop depression because of the severity of their symptoms.
Support groups for patients with cervical dystonia in Tennessee include the National Spasmodic Torticollis Association Nashville Support group which can be contacted via email at firstname.lastname@example.org