About Spasmodic Torticollis (Cervical Dystonia)
Spasmodic torticollis is a condition characterized by atypical twisting of the neck and head. The causes of spasmodic torticollis can be both genetic and environmental.
Causes of spasmodic torticollis include:
- Genetic: Doctors believe that there is a genetic component to spasmodic torticollis, meaning that it can run in families. However, the specific genes involved have not yet been identified.
- Environmental triggers: While the exact environmental triggers are not fully understood, certain factors such as stress or trauma may contribute to the development of spasmodic torticollis.
Non-modifiable risk factors are factors that cannot be changed or controlled. Non-modifiable risk factors of spasmodic torticollis include:
- Age: Spasmodic torticollis can develop at any age, but it most commonly begins in middle age.
- Gender: Both men and women can develop spasmodic torticollis, but it is slightly more common in women.
Here are the most common early symptoms of spasmodic torticollis:
- Neck pain
- Abnormal head position or posture: Patients may have their head rotated to one side and tilted to the other, a position known as "cock-robin position."
- Neck stiffness
- Muscle spasm: On physical examination, muscle spasm of the neck muscles is usually observed. The sternocleidomastoid muscle, located in the front of the neck, may be particularly affected.
- Upper airway infections
As spasmodic torticollis progresses or becomes more severe, additional symptoms may occur, including:
- Radiating pain: The pain may spread to other areas such as the occipital region (back of the head), face, and ears. This can be caused by nerve compression.
- Neurological symptoms: In most cases, neurological symptoms are not present due to the looseness of the vertebral canal at this level. However, in rare cases where there is displacement of a specific vertebra neurological involvement may occur.
When diagnosing spasmodic torticollis, healthcare providers commonly perform a series of examinations, tests, and procedures to gather information and determine the severity of the condition. Here are some of the common ones:
- Medical History: The healthcare provider will gather information about your medical history and any previous diagnoses to understand your overall health and identify any potential risk factors for spasmodic torticollis.
- Physical Exam: The healthcare provider will conduct a physical exam to look for physical signs of spasmodic torticollis, such as neck pain and stiffness.
- Lab Tests: Specific lab tests may be recommended by your healthcare provider to help diagnose spasmodic torticollis. These tests often involve checking a sample of your blood, urine, or body tissues. The type of lab tests ordered will depend on your symptoms and the diseases being considered.
- Imaging Studies: These studies allow doctors to look inside your body for clues that can help with diagnosis and treatment planning. The type of imaging study chosen depends on your symptoms and the part of the body being examined. An example is Uultrasonographic (USG) examination. This examination involves using ultrasound technology to assess the sternocleidomastoid (SCM) muscle in the neck. It can provide valuable information about muscle abnormalities associated with spasmodic torticollis
- Ophthalmologic Screening: If there is a suspicion of visual abnormalities related to spasmodic torticollis, such as ocular misalignment, nystagmus, or strabismus, an ophthalmologic screening may be requested for further evaluation.
- Neurologic Examinations: Neurologic examinations are performed by a specialized pediatric physiatrist to assess any neurological abnormalities associated with spasmodic torticollis.
- Three-Dimensional Volume-Rendered Computed Tomography (3D-CT): In cases where cervical alignment and morphology are not evident on X-rays and ultrasound does not show any abnormalities, a 3D-CT scan of the cervical spine may be performed to evaluate for possible vertebral anomalies.
The goals of treatment for spasmodic torticollis are to reduce symptoms, improve quality of life, and increase mobility. There are several treatment options available to achieve these goals, including:
- Medications:
- Botulinum toxin injections: Botulinum toxin, commonly known as Botox, is the preferred treatment for spasmodic torticollis. It works by blocking the release of acetylcholine, a neurotransmitter that causes muscle contractions. By injecting Botox into the affected muscles, it temporarily weakens them, reducing involuntary movements and abnormal postures.
- Oral medications: These can help reduce muscle spasms and pain associated with spasmodic torticollis. Examples include muscle relaxants like baclofen and anticholinergic drugs like trihexyphenidyl.
- Therapies:
- Physical therapy: A physical therapist can provide exercises and stretches to improve posture, strengthen muscles, and increase range of motion.
- Occupational therapy: An occupational therapist can help with daily activities by suggesting modifications or assistive devices to make tasks easier.
- Speech therapy: If spasmodic torticollis affects the muscles involved in speech, a speech therapist can provide techniques to improve communication.
- Therapeutic procedures:
- Denervation procedures: These surgical procedures involve selectively cutting or removing nerves that control the affected muscles. The McKenzie operation and Bertrand procedure are examples of denervation procedures used for spasmodic torticollis.
- Deep brain stimulation (DBS): DBS involves implanting electrodes in specific areas of the brain that control movement. These electrodes deliver electrical impulses to regulate abnormal brain activity and reduce symptoms.
- Self-care and health behavior changes:
- Stress management: Stress can worsen symptoms of spasmodic torticollis. Practicing stress-reduction techniques like deep breathing exercises, meditation, or engaging in hobbies can help manage stress levels.
- Good sleep habits: Adequate sleep is important for overall health and can help manage symptoms of spasmodic torticollis. Establishing a regular sleep schedule and creating a relaxing bedtime routine may be beneficial.
It's important to note that the effectiveness of each treatment option may vary from person to person. A healthcare professional will assess individual needs and recommend the most appropriate treatment plan based on the severity of symptoms, response to previous treatments, and personal preferences.
The natural progression of spasmodic torticollis can vary from person to person. Some individuals may experience a gradual worsening of symptoms over time, while others may have periods of stability or even improvement.
Complications commonly associated with spasmodic torticollis include:
- Chronic pain: Many individuals with spasmodic torticollis experience neck or shoulder pain as a result of the abnormal muscle contractions. This chronic pain can significantly impact their quality of life.
- Limited range of motion: The involuntary muscle contractions can restrict the movement of the neck, leading to difficulties in performing daily activities that require neck mobility.
- Impaired posture: Spasmodic torticollis can cause abnormal head and neck postures, which may lead to issues with balance and coordination.
- Impact on psychological well-being: Living with a chronic condition like spasmodic torticollis can have emotional and psychological effects. Some individuals may experience feelings of frustration, embarrassment, or social isolation due to the visible symptoms of the condition.
The goal of treatment for spasmodic torticollis is not to cure the condition but rather to alleviate symptoms, slow down disease progression, and improve quality of life. It's important for individuals with spasmodic torticollis to work closely with their healthcare provider to determine the most appropriate treatment plan for their specific needs.