Q: Just what is cervical dystonia? How serious can this condition be or get and how does a person get it? I would like as much information as you can give me because I have it in my neck, back and at the back of my head. Thank you for your time.
A: Cervical dystonia, also known as spasmodic torticollis, is a condition in which the neck muscles contract involuntarily, resulting in the head leaning forward or backward, or twisting to one side. There may be a tremor present. The disorder is more prevalent in women than in men and is more likely to occur in people between the ages of 40 and 70. As with countless other conditions, a family history will increase a person’s risk of developing the condition that may begin slowly and worsen with time but will reach a stage where it will level off without increasing in intensity. As the muscles contract and the head no longer remains in alignment, headaches and neck pain may appear.
The cause for a person to develop cervical dystonia remains somewhat elusive but may be linked with an injury to the head, neck or shoulder area of the body, damage to the basal ganglia or other brain regions that control movement, or through the use of specific drugs including those taken for nausea or anti-psychotics.
Diagnosis is commonly made by visual examination, however other testing may be ordered by a health care professional to rule out possible underlying conditions. For example, lab testing may reveal toxins in the blood. Magnetic resonance imaging (MRI) may identify a tumor or evidence of a stroke. Electromyography will measure the electrical activity of muscles and will assist in the confirmation of diagnosis.
Previously, dystonia was divided into three groups – idiopathic, genetic and acquired that I will identify for clarity; however, as of February 2013, dystonia is classified by age of onset, anatomic distribution and cause. The idiopathic form indicates the presence of the condition without a clear reason for it to appear. Genetic forms may be inherited in a dominant manner, meaning only one parent carrying the defective gene passes it on to a child. Each child of a parent with the abnormal gene will then have a 50% chance of carrying the defective gene; however, in some cases those who do inherit the defective gene may not even develop dystonia. Acquired dystonia is the result of damage to the brain, exposure to specific medications, to heavy metal or carbon monoxide poisoning, stroke, or other conditions. If dystonia is found related to the ingestion of medication, symptoms may disappear if the drug is discontinued rapidly for some individuals, while symptoms may persist even after the medication is withdrawn in other cases.
Treatment will depend on the extent of symptoms and may include muscle relaxants, pain medication, BOTOX, and drugs commonly prescribed to treat Parkinson’s tremors. Pain relievers will vary in range from over-the-counters to more powerful prescription drugs. BOTOX can be injected directly into the affected neck muscles, allowing for almost immediate improvement but the injections will likely need to be repeated every three to four months. If Parkinson’s drugs such as benztropine are ordered, they will likely be given in combination with the BOTOX injections for a reduction in symptoms. Finally, surgery is a possibility when more conservative measures fail to provide relief.
On the home front, massage therapy may prove effective, as will the use of heat packs to relax the constricted muscles, and incorporating stress reduction techniques such as displacing oneself from difficult situations. There is a self-help group, the National Spasmotic Dystonia Association found at www.torticollis.org.
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