What is Spasmodic Torticollis?
Spasmodic (adult on-set) Torticollis also known as Cervical Dystonia is a rare neurological movement disorder which is characterized by debilitating pain in the neck due to involuntary contraction of neck muscles leading to twisting of head to one side or uncontrollable forward or backward tilting of head.
3 in every 10,000 people are affected by this condition in the USA alone. Women are more prone to it when compared to men. Middle age people are usually affected, although records show its occurrence in some infants as well.
Causes of Spasmodic Torticollis:
- The primary cause is thought to be a dysfunction of the brain.
- Injury to shoulder or head or neck could also lead to it.
- Some anti nausea or antipsychotic medications may also cause the condition.
- It could be genetic. Nearly 5% people who develop this condition have a family history of it and 50% of them have a family history of tremors in hands or head.
- It could also be the result of some other conditions such as lesions in brain stem.
Symptoms of Cervical Dystonia:
Symptoms usually begin between the age of 25 and 55, touching the peak between the age of 30 and 40. These include:
- Symptoms begin to show up gradually and get noticed when a person struggles to keep his/her head straight.
- Between 2 and 5 years the condition progresses to a peak level and stops worsening further.
- Back of the shoulders or side of the neck are the places where the pain manifestation is high.
- Neck pain that radiates to any one shoulder.
- Neck contractions and spasms that lead to abnormal head position, twisting it in different directions such as ‘chin straight up’, ‘chin toward shoulder’, ‘chin straight down’ and ‘ear toward shoulder.’
- Symptoms may resemble to the ones common in some other disorders such as muscular dystrophy, Parkinson’s disease, epilepsy and wry neck (acute neck pain and neck spasm that usually lasts for a few days).
Three varieties of Spasmodic Torticollis have been identified.
- 1. Clonic – shaking of the head.
- 2. Tonic – turning of the head to one side.
- 3. Mixed – involves both shaking and turning of the head.
Turning of the head is further classified as:
- Laterocollis – head pulled towards the shoulder.
- Rotational – head turned to one side.
- Anterocollis – head pulled forward.
- Retrocollis – head pulled backwards.
Treatment for Spasmodic Torticollis:
Unfortunately, there is no cure for this neurological condition. Some people may stop experiencing the symptoms without any treatment whereas in some others, symptoms may recur even after undergoing treatment. Treatment options include:
- Symptomatic movements of the head and neck may disappear temporarily during sleep and do not reappear for about 10 minutes to 4 hours after waking up. Taking advantage of this situation, many patients prefer lying down at frequent intervals during the day.
- Spasms may also cease temporarily by touching the opposite side of the chin or cheek.
- In people with mild symptoms and below 40 years of age, recovery is seen within 5 years of the on-set of the symptoms in nearly 20% of them.
- Chemodenervation is a process of contracting muscles using MYOBLOC (botulinum toxin type B) or BOTOX (botulinum toxin type A).
- Over the counter pain medications may be taken for pain relief.
- Muscle relaxants such as Ativan (lorazepam), Valium, Diastat (diazepam), Lioresal (baclofen) and Klonopin (clonazepam) may also be taken for pain relief.
- Neck strength and flexibility can be improved by practicing neck exercises regularly.
Spasmodic Torticollis may lead to depression in some patients. Doctors usually suggest a multi-disciplinary approach to treat this condition which includes a combination of 2 or more above mentioned options.