Cervical dystonia (spasmodic torticollis)

Cervical dystonia, also known as spasmodic torticollis, is a focal dystonia characterized by neck muscles contracting involuntarily, causing abnormal movements and awkward posture of the head and neck. The movements may be sustained (“tonic”), jerky (“clonic”), or a combination. Spasms in the muscles or pinched nerves in the neck can result in considerable pain and discomfort. Cervical dystonia may be primary or secondary.

Terms used to describe cervical dystonia include: spasmodic torticollis, torticollis, adult onset focal dystonia. Specific words may be used to describe the position of the neck: laterocollis (head tilts to side); retrocollis (head tilts back), anterocollis (head tilts forward).

Symptoms
In cervical dystonia, the neck muscles contract involuntarily. If the contractions are sustained, they may cause abnormal posture of the head and neck. If the spasms are periodic or patterned, they may produce jerky head movements. The severity of cervical dystonia varies from mild to severe. Movements are often partially relieved by a “sensory trick” (also known as geste antagoniste) such as gently touching the chin, other areas of the face, or back of the head.

Cervical dystonia may begin in the neck and spread into the shoulders, but the symptoms usually plateau and remain stable within five years of onset. This form of focal dystonia is unlikely to spread beyond the neck and shoulders or become generalized dystonia. Occasionally, people with cervical dystonia develop other focal dystonias.

Cause
Cervical dystonia may be primary (meaning that it is the only apparent neurological disorder, with or without a family history) or be brought about by secondary causes such as physical trauma. Cases of inherited cervical dystonia may occur in conjunction with early-onset generalized dystonia, which is associated with the DYT1 gene.

Diagnosis
Diagnosis of cervical dystonia is based on information from the affected individual and the physical and neurological examination. At this time, there is no test to confirm diagnosis of cervical dystonia, and in most cases assorted laboratory tests are normal.

Cervical dystonia should not be confused with other conditions which cause a twisted neck such as local orthopedic or congenital problems of the neck, or ophthalmologic conditions where the head tilts to compensate for impaired vision. It is sometimes misdiagnosed as stiff neck, arthritis, or wryneck.

Treatment
One of the most effective treatments for cervical dystonia is regular botulinum toxin injections to the affected muscles. A multitude of oral medications have demonstrated some benefit. The categories of drugs reported to help relieve the symptoms associated with cervical dystonia include anticholinergic drugs such as Artane ®(trihexyphenidyl) and Cogentin® (benztropine); dopaninergic drugs such as Sinemet® or Madopar® (levodopa), Parlodel® (bromocriptine), and Symmetrel® (amantadine); and GABAergic drugs such as Valium® (diazepam).

Selective denervation surgery is an option for some cervical dystonia patients, and deep brain stimulation surgery is beginning to be explored for cervical dystonia as well.

Gentle physical therapy with a physical therapist who specializes in neurological disorders may improve range of motion and help reduce pain.

Complementary therapies should be explored and regular relaxation practices may significantly benefit discomfort and pain.

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