Dystonia defines a group of movement disorders characterized by slow repetitive involuntary muscle spasms and contractions. Cervical dystonia, also referred to as spasmodic torticollis or torticollis, is a type of dystonia and a painful condition in which neck muscles contract involuntarily causing the head to twist or pull to one side. The condition can also cause the head to tilt forward or backward uncontrollably.
Causes of Cervical Dystonia
The cause of cervical dystonia is not clear. It may be inherited, associated with other conditions such as stroke, Parkinson’s disease, multiple sclerosis, brain tumors, and brain infections, or may be caused by injury to the head, neck, or shoulders, certain medications, or abnormalities in parts of the brain controlling movement. Risk factors for developing cervical dystonia include people in the age group of 30 to 40, family history of dystonia, and female gender (women are twice as likely to develop cervical dystonia than men).
Signs and Symptoms of Cervical Dystonia
Pain is the most common and challenging symptom of cervical dystonia. The pain is normally on the same side of the head as the tilt. The most typical abnormal movement in cervical dystonia is a twisting of the chin and head sideways, toward the shoulder, known as torticollis. Other abnormal head movements include:
- Tilting sideways, ear to shoulder, called laterocollis
- Tilting backward, chin upward, known as retrocollis
- Tipping forward, chin downward, called anterocollis
Some patients may have a combination of these movements. Besides, the symptoms may differ over time and by the patient. Stress or excitement may worsen symptoms. In addition, some physical positions may trigger symptoms. The symptoms normally begin gradually. They may get worse and then reach a plateau. Other symptoms may include:
- Neck pain that radiates to the shoulders
- A raised shoulder
- Hand tremors
- Head tremor, which affects about 50 percent of individuals with cervical dystonia
- Abnormal growth of the neck muscle, which affects about 75 percent of individuals with cervical dystonia
Diagnosis of Cervical Dystonia
In order to diagnose cervical dystonia, your physician will conduct a review of your medical history and perform a thorough physical examination. In most cases, physical examination alone is sufficient to confirm the diagnosis of cervical dystonia. However, your physician may also order blood tests and imaging tests such as magnetic resonance imaging (MRI) to rule out any underlying conditions that may be causing your signs and symptoms.
Treatment for Cervical Dystonia
There is no cure for cervical dystonia. Hence, treatment mainly focuses on providing symptomatic relief. Medications such as Botulinum (Botox) toxin injections may be prescribed to be injected into the neck muscles to reduce contractions which may help with abnormal posturing. Medications and muscle relaxants can be effective with early-onset dystonia. Physical therapy is another effective treatment. This involves heat and massage to relax your shoulder and neck muscles as well as targeted strengthening and stretching exercises to improve posture. When conservative treatment measures do not relieve symptoms, your doctor may suggest surgical procedures such as deep brain stimulation (electrodes are implanted in the brain to control muscle contractions) or selective peripheral denervation (nerve endings are severed to prevent painful spasms).