Cervical Dystonia
Cervical dystonia is a neurological condition characterized by excessive contraction of the muscles of the neck and shoulders, resulting in abnormal movements of the head (dystonia). Most commonly, the head turns to one side or the other. Tilting to the side, back, or front may also occur. The turning or tilting movements may be accompanied by tremors and/or soreness of the muscles of the neck and shoulders. Cervical dystonia can occur at any age, but most cases occur in middle age. The cause of cervical dystonia is often unknown.
People with Cervical dystonia can receive expert diagnosis and treatment at Neurology One. Cervical dystonia is also known as spasmodic torticollis. In this condition the neck muscles contract involuntary. This results in twisting, turning or tilting of the head. Tremors may also be observed, and most people have pain associated with it. Cervical dystonia can result in uncontrollable forward or backward head tilt. Our doctors have been treating people with cervical dystonia for over 20 years, and understand how this can affect the quality of life of the patients and also their caregivers.
It can affect individuals of any age but is more commonly seen in middle-aged people. It is more common in women than men. It occurs gradually before reaching a stable state of symptoms.
Cervical dystonia has no cure, but botulinum toxin injections can reduce symptoms for some individuals. Sustained remissions are rare, and surgery may be an option for a few cases.
To effectively control and treat the condition, the team at Neurology One includes top neurologists in Orlando, nurses, physical therapists, and rehabilitation specialists.
What are the Symptoms of Cervical dystonia?
These are the directions in which cervical dystonia’s muscle contractions can cause head twisting.
- Chin straight up
- Chin toward shoulder
- Ear toward shoulder
- Chin straight down
Cervical dystonia’s most frequent twisting form is the chin pulled towards the shoulder. Some individuals may experience a combination of irregular head postures and sudden head jerking.
Cervical dystonia often results in neck pain that spreads to the shoulders. In addition, the disorder can be associated with headaches. The pain experienced can be intense and debilitating for some individuals.
Symptoms typically start slowly and may intensify before leveling off. Symptoms may include:
- Neck pain radiating to shoulders
- Raised shoulder
- Headache
- Head tremor (50% of cases)
- Enlarged neck muscle (75% of cases)
- Unawareness of movements not affected by dystonia
The cause of cervical dystonia is unknown in most cases, but a family history of the disorder and gene mutations have been implicated. Sometimes, it may be a complication of using certain medicines. It may also be linked to head, neck, or shoulder injuries.
Cervical dystonia is associated with the following risk factors:
1. Age
The disorder can affect people of any age, but it most commonly occurs after age 30.
2. Family history
You are more likely to develop cervical dystonia if you have a close family member with the disorder.
3. Sex
Cervical dystonia is more likely to affect women than men.
4. Neurological disorders
Including Parkinson's.
5. Antipsychotics
And other dopamine-blocking medication.
What are the Risk factors?
Cervical dystonia affects 60,000 people in the US. Those who are at risk include:
- Women are affected 2x more as men
- 40-60-year-olds are at risk
- A family history of dystonia increases the risk
Treatment at Neurology One
In Orlando, Neurology One provides extensive care to patients with Cervical dystonia.The treatment for cervical dystonia has advanced in recent times. Physical therapy and counseling, specifically for stress management, can also aid in managing symptoms.
Physical therapy
Physical therapy benefits cervical dystonia patients, including massage, heat therapy, targeted stretching, and strengthening exercises.
A 2012 study of 20 individuals with cervical dystonia in Brazil showed improvement in pain, symptoms, and quality of life with physical therapy.
Physical therapy for cervical dystonia includes:
- Exercises to counter muscle twist
- Kinesiotherapy for neck movement and stretching
- Muscle electrical stimulation
Biofeedback
Biofeedback uses electronic instruments to monitor muscle activity, blood flow, and brain waves. This provides this information to aid in managing involuntary motions in cervical dystonia patients.
A 2013 study showed significant pain relief and improved quality of life with biofeedback.
Deep Brain Stimulation
Deep brain stimulation (neuromodulation) is a modern treatment option. It entails the insertion of electrical leads into the brain via a small hole in the skull, connected to a battery near the collarbone via skin-under wires.
The patient uses a remote to deliver low-voltage electric current to nerves causing involuntary head and neck movements.
Exercise
Physical therapists can design safe at-home exercises to relieve symptoms and strengthen muscles. Simple sensory tricks like touching the opposite side of the face, chin, cheek, or back of the head during a spasm can also help, but effectiveness may reduce over time.
Getting Relief from Pain
Botulinum toxin
The most widely used method to alleviate the discomfort associated with cervical dystonia is administering botulinum toxin injections into the neck muscles every 11 to 12 weeks. This approach immobilizes the affected nerves, reducing pain and improving symptoms for an estimated 75% of individuals with the condition.
A 2008 study emphasized the importance of using electromyography, a diagnostic tool that measures muscles’ electrical activity, to accurately identify the specific muscles for botulinum toxin injections.
Several botulinum toxin drugs are available, including Botox, Dysport, Xeomin, and Myobloc. Botox, in particular, has become a well-known brand due to its widespread use in cosmetic treatments to smooth out wrinkles.
Medications
The effectiveness of various drugs and treatment combinations can differ significantly among individuals, so what may be effective for one person may not necessarily bring relief to another.
The Dystonia Foundation highlights various oral medications that can effectively manage the symptoms of cervical dystonia. These include:
- Anticholinergics, such as Artane and Cogentin, inhibit the action of the neurotransmitter acetylcholine.
- Dopaminergic, like Sinemet, Parlodel, and Symmetrel, target dopamine neurotransmission.
- GABAergics, including Valium, act on the GABA-A neurotransmitter.
- Anticonvulsants, including Topamax, which is commonly used for treating epilepsy and migraines and have shown positive results in managing symptoms of cervical dystonia.
It is essential to consult your neurologist regarding the potential side effects of these medications before starting a treatment.
Surgery
In cases where conservative treatments fail, surgical procedures may be considered for cervical dystonia.
Older surgical methods involve cutting nerves in the brain responsible for involuntary head movements.
Cervical Dystonia is a severe neurological condition causing pain and disability and exacerbated by stress, with no cure currently known.
Most likely, you’ll receive a combination of treatments, including:
- botulinum toxin
- counselling
- physical therapy
- Surgery, if necessary
How is cervical dystonia diagnosed?
Your physician will examine your symptoms and conduct a thorough physical evaluation. They will inquire about any existing health issues. Tests may assess muscle function and pinpoint the cause of muscle contractions.
Living with cervical dystonia
Cervical dystonia is a chronic condition without a cure. However, it does not shorten life expectancy. Some individuals may experience symptom-free periods, referred to as remissions. If pain is a symptom,talk to your neurologist to manage it. Dystonia may affect other parts of the body, including voluntary muscles. Reducing stress can help alleviate symptoms, as stress can exacerbate them, even though it is not a cause of dystonia.
So,It is best to consult with a specialist at Neurology One for a comprehensive evaluation and personalized treatment plan. The best Neurologists in Orlando, including clinically trained neurologists and specialists offer expertise in Cervical dystonia management and treatment.