Does early menopause affect cervical dystonia?

Question

Hello doctor,

I am reaching out concerning my 34-year-old daughter, who has been managing cervical dystonia for the past two years. Recently, her condition has intensified, coinciding with the onset of early menopause.

She experiences involuntary contractions causing her neck to turn to the right, which she cannot control despite her efforts. Previously, she received botulinum toxin injections every three months with satisfactory results. However, the efficacy has diminished, necessitating more frequent treatments.

Approximately eight months ago, her menstrual cycles ceased entirely. Her gynecologist reported significantly low estrogen levels (12 pg/ml). Notably, during periods corresponding to her former premenstrual phase, she endures exacerbated muscle spasms.

Additionally, she has developed painful contractions in her dominant hand, complicating her responsibilities as a teacher. An attempt to manage symptoms with baclofen resulted in excessive drowsiness, impairing her daily functioning.

Her neurologist has mentioned deep brain stimulation as a potential intervention. However, she harbors concerns regarding surgical procedures. The persistent muscle pulling severely affects her ability to perform routine tasks, such as reversing her car, and disrupts her sleep.

Given these developments, we are seeking your expertise to explore safe and effective treatment options that consider the interplay between early menopause and cervical dystonia. Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concerns.

I am truly sorry to hear about the challenges your daughter is facing; navigating early menopause alongside cervical dystonia (a neurological condition characterized by involuntary muscle contractions in the neck, leading to abnormal head postures and movements) is undoubtedly demanding.

Hormonal considerations

Given her notably low estrogen levels (12 pg/ml), it is possible that hormonal fluctuations are influencing her dystonia symptoms. Discussing hormone replacement therapy, or HRT (a medical treatment designed to alleviate symptoms associated with menopause by supplementing the body with hormones such as estrogen and progesterone), with her gynecologist could be beneficial, as some studies suggest that estrogen may play a role in modulating movement disorders.

Medication adjustments

Exploring Botox alternatives: If Botox is no longer effective, consider discussing Daxxify (dantrolinium toxin A-lanm) with her neurologist. Daxxify is a longer-lasting neurotoxin approved for treating cervical dystonia (explain), potentially offering extended symptom relief.
Gentler medications: Trihexyphenidyl has been used to manage dystonia symptoms, and combining it with Clonazepam at bedtime may enhance efficacy.
Non-pharmacological therapies: Sensorimotor retraining therapy (a technique for recovery meant to increase sensory and motor capacity after surgery, injury, chronic pain, or neurological disorders), such as the John Pepper method (a method that emphasizes intentional, mindful movement to retrain the brain and improve motor function), has shown promise in helping individuals regain control over their movements.

Surgical considerations

Deep brain stimulation (DBS), a neurosurgical treatment in which electrodes are implanted into deep brain regions, has been effective for individuals with severe cervical dystonia who have not responded to other treatments. Seeking a second opinion at a specialized movement disorder center can provide valuable insights into whether DBS is a suitable option for her.

Daily supportive measures

Heat therapy and stretching: Applying warm packs and gentle neck traction before bedtime may alleviate muscle tension.
Driving aids: Using convex mirrors can enhance parking safety.
Hand support: Wearing a wrist brace during writing can provide additional support.

While this journey may feel overwhelming, a coordinated approach involving neurology and gynecology specialists can offer pathways to relief and improved quality of life.

I hope this helps.

Kindly revert if there is any query.