Cervical Dystonia

Cervical dystonia, also called spasmodic torticollis, is a rare and painful condition characterized by involuntary contraction of your neck muscles. Neck muscle spasms can cause abnormal movements and posture of the head and neck such as your head tilting forward or backward.

While the condition can affect people of any age, it is most commonly seen in middle-aged people, women outnumbering the men.

The symptoms reach a plateau after gradual progression. Sometimes, spontaneous remission is possible but sustained remission is rare.

Till now, no cure for cervical dystonia has been found but botulinum toxin injection at the affected site often reduces the signs and symptoms of cervical dystonia.

Rarely, surgery may be considered.

Neck muscle spasms is the main symptom of Cervical dystonia. Neck muscle spasms in cervical dystonia can cause abnormal and awkward movements and posture of the head, such as:

• Chin pulled towards shoulder
• Ear tilting towards shoulder
• Chin straight up
• Chin straight down
• Chin is pulled toward your shoulder (the most common symptom)
• A jerking motion of the head
• Persistent muscle contraction can cause neck pain that can radiate into the shoulders.
• Headaches
• Disabling neck pain
• Exhaustion (due to pain)

The cause of cervical dystonia is still unknown. However, in some cases, your cervical dystonia can be caused by head, neck or shoulder injuries.

Antipsychotic or anti-nausea medications can trigger the condition in some people.

If you have any symptoms of cervical dystonia, talk to your doctor to receive a diagnosis. Your doctor may refer you to a neurologist, a specialist in brain and nervous system disorders.

How to prepare yourself for the visit?

Following tips may be useful:

• List out all the symptoms
• Write down your key medical information.
• Mention if you have a family history of this or similar condition.
• Write down the names of all your medications, vitamins or supplements.
• Make a list of the questions to ask your doctor. Some typical question can be:
• What could be the possible cause/s of my symptoms?
• What are treatment options for my condition? Which one do you think will work the best for me?
• What are the tests do I need to take?
• What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor.

Your doctor might ask you typical questions like:

• When did the symptoms start appearing?
• Is there anything that relieves or worsens your symptoms?
• What medications do you take?
• Do you have a history of a stroke or head injury?

Physical examination is enough for confirming cervical dystonia but your doctor can recommend following tests to determine if some underlying conditions could be the reason behind your signs and symptoms.

Tests may include:

• Blood or urine tests: These tests can help determine if you harbor some toxins.
• Magnetic resonance imaging (MRI): MRI uses powerful radio waves and magnets to produce detailed images of various parts of your body. An MRI may help identify and visualize tumors or evidence of stroke.
• Electromyography (EMG): Electromyography (EMG): An EMG measures nerve’s electrical activity during signal transmission to muscles. It helps to differentiate cervical dystonia from other similar conditions.

No treatment for cervical dystonia has been found yet. Some people are lucky to have spontaneous remission but the disease often returns. The treatment aims to relieve the associated signs and symptoms.

Medications

• Botulinum toxin: Injection of botulinum toxin, a neurotoxic protein produced by the bacteria Clostridium botulinum, is approved for use in cervical dystonia to relieve signs and symptoms of the condition. It is injected directly into the affected neck muscles and must be repeated every three to four months.
• Parkinson's drugs: Combination of certain Parkinson's drugs with botulinum toxin injections have shown favorable results in some cases of cervical dystonia. Some common side effects of these drugs are dry mouth, constipation, memory problems, reduced urinary stream or visual blurring.
• Muscle relaxants: Drugs like diazepam, lorazepam, clonazepam and baclofen may be helpful in treating neck muscle spasms associated with cervical dystonia. Sedation, imbalance and mild cognitive impairment are some common side effects of these drugs.
• Pain medications: Pain associated with cervical dystonia may be treated with over-the-counter pain relievers or prescription pain relievers, the choice of which depends upon severity of the pain.

Therapy

You may consult a physical therapist to learn exercises that strengthen your neck and shoulder muscles.

• Neck brace: When properly used, a neck brace can help relieve some signs of cervical dystonia.
• Surgical and other procedures: Surgery is a treatment option reserved for the condition when no other treatment can provide satisfactory results. Some examples of surgery include:
• Selective denervation surgery: Those who don’t respond to botulinum toxin or other medications may have to undergo this surgery to cut the nerves or muscles that cause awkward posture.
• Deep brain stimulation (DBS): Deep brain stimulation is a surgical procedure in which the nerve signals that cause head twist are interrupted by externally supplied electrical impulses.

Lifestyle modifications are necessary in order to cope with Cervical dystonia.

Cervical dystonia is incurable but definitely it is manageable.

Here are some suggestions to manage cervical dystonia:

• Reduce stress: Stress can trigger signs and symptoms of cervical dystonia. So, you need to learn how to manage your stress well.
• Get your rest: A good sleep and rest can help you manage the symptoms of cervical dystonia.
• Use heat: Heat packs could be used to relieve pain associated with cervical dystonia.
• Try touching: A simple practice, also called Sensory tricks, relaxes the spasms associated with cervical dystonia.
• Join a support group: Talk to your doctor to find out a support group near you.

There are several risks and complications associated with Cervical dystonia.

Risk factors

• Age: Cervical dystonia may affect people of any age but most commonly people over 40 are affected.
• Sex: Women outnumber men when it comes to developing cervical dystonia.
• Family history: A family history of cervical dystonia increases your risk for developing the disorder.

Complications

• Spreading: The disease may sometimes spread to other areas in the neighboring parts.
• Depression: Due to the chronic nature of the disorder, you might find yourself depressed. Seek medical help if you develop any depressive symptoms.