What Is Cervical Dystonia?
Cervical dystonia, often called spasmodic torticollis, is a rare, painful neurological condition characterized by involuntary contractions of the neck muscles. These contractions cause the head to twist or turn to one side or tilt forward or backward. Although cervical dystonia can happen at any age, it is more likely to occur in middle-aged people and women than in men. Also, cervical dystonia can affect people of all ethnic backgrounds. No specific cure exists for cervical dystonia. The condition sometimes resolves without treatment, but sustained remissions are rare.
What Are the Symptoms of Cervical Dystonia?
Symptoms usually begin slowly and then reach a point where they do not worsen and stabilize.
However, the involuntary muscle contractions involved in cervical dystonia can cause the head to twist in various directions, including:
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Ear toward the shoulder.
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Chin toward the shoulder. This is the most common type of twisting associated with cervical dystonia.
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Chin straight up.
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Chin straight down.
Some people may have a combination of these motions. They may vary over time and by an individual. Some people can also experience the jerking motion of the head. Many people with cervical dystonia also complain of neck pain that can radiate into the shoulders, and in some people, the pain can be exhausting and disabling. The condition can also cause headaches.
What Causes Cervical Dystonia?
In most cervical dystonia cases, the exact cause is unknown; when the cause is unknown, it is called primary dystonia. Some individuals with cervical dystonia have a family history of the disorder. Cervical dystonia is sometimes associated with head, neck, or shoulder injuries, a stroke, or Parkinson's disease (secondary dystonia). In addition, researchers have found gene mutations linked with primary and secondary cervical dystonia. Nerve damage resulting from certain medicines (such as haloperidol and other antipsychotic drugs) is another potential cause. Stress and emotional problems may make cervical dystonia worse.
What Are the Complications of Cervical Dystonia?
The possible complications include:
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The spread of involuntary muscle contractions to other nearby body parts, most commonly in the face, jaw, arms, and trunk.
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Some people may develop bone spurs in the spine that reduce the amount of space in the spinal canal. This can result in tingling, numbness, and weakness in the arms, hands, legs, or feet.
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Cervical spine arthritis
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People with cervical dystonia also have a higher risk of anxiety and depression.
How Is Cervical Dystonia Diagnosed?
The doctor reviews the symptoms and performs a physical examination. The doctor also takes a complete medical history to know about any health conditions one may have. While only a physical examination can often confirm a diagnosis of cervical dystonia, in some instances, the doctor might recommend blood tests or magnetic resonance imaging (MRI) to detect any underlying condition causing the signs and symptoms. For example, cervical dystonia can resemble acute pain, stiff neck, or spasm that goes away.
What Is the Treatment for Cervical Dystonia?
There is no specific cure for cervical dystonia. In some people, may vanish without treatment, but recurrence is common. Pain is the main symptom of cervical dystonia. Therefore, treatment focuses on easing the signs and symptoms. In addition, people respond individually to different types of medications and combinations of treatments.
- Botulinum Toxin: It is a paralyzing agent commonly used to smooth facial wrinkles and can be injected directly into the neck muscles affected by cervical dystonia. This helps immobilize the nerves in the neck muscles and relieves the pain and other associated symptoms. These injections must be repeated every three to four months. The doctor may also prescribe oral medications with a muscle-relaxing effect to improve results or to help decrease the dosage and frequency of botulinum toxin injections.
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Medications: Various oral medications are documented to help relieve the symptoms associated with cervical dystonia.
These medications include:
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Anticholinergics, such as Trihexyphenidyl and Benztropine.
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GABAergics, such as Diazepam.
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Dopaminergic, such as Levodopa, Bromocriptine, and amantadine.
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Anticonvulsants, such as Topiramate.
Ensure to first discuss with the doctor the side effects of these medications.
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Exercises: A physical therapist can assist with specific exercises one can safely do at home to alleviate symptoms and strengthen muscles. Simple sensory tricks, like touching the opposite side of the face, chin, cheek, or the back of the head, can cause spasms to stop temporarily. These tricks, however, lose effectiveness as the disease progresses.
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Physical Therapy: This includes heat packs, massage to relax the neck and shoulders, and targeted stretching and strengthening exercises to improve neck strength and flexibility.
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Stress Management: The signs and symptoms associated with cervical dystonia tend to worsen when stressed, so learning stress management techniques or coping with stress is also essential.
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Surgery: If conservative treatments do not help, the doctor may suggest surgery. These may include:
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Deep Brain Stimulation (DSB): This procedure involves placing electrodes (thin wires) into the portion of the brain called globus pallidus by drilling a small hole cut into the skull. These electrodes are connected to stimulators which send electrical pulses to interrupt the nerve signals responsible for involuntary head and neck movements.
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Cutting The Nerves: This is another option to sever the nerves taking the contraction surgically signals to the affected muscles.
What Is the Outlook for People With Cervical Dystonia?
Cervical dystonia is a lifelong disease with no known cure yet. However, it does not lower the expected lifespan. Some people can go into remission with treatment. However, it can involve significant physical pain and disability and is often worsened by stress. If cervical dystonia causes pain, work with a doctor to help control it. Unfortunately, cervical dystonia cannot be prevented or avoided.
Conclusion
Cervical dystonia is a neurological disease characterized by involuntary contractions of the neck muscles, causing the neck to twist or turn in different ways. The exact cause of cervical dystonia is still unknown. The diagnosis is based on symptoms and the results of the physical examination. There are three treatment options available: botulinum toxin injections, oral medications, and, in some cases, surgery, and these treatments may be used alone or in combination. Unfortunately, cervical dystonia cannot be prevented or avoided.
