Mark W. McFarland, DO
Cervical Dystonia, also called spasmodic torticollis, is a painful disorder that causes twisting or turning of the head due to involuntary spasms of the muscles in the neck. It can cause the head to twist in a variety of directions, like chin to chest, chin straight up or down or ear to shoulder. The head may also jerk abnormally. Headaches and pain in the shoulders and neck are common, and often debilitating.
For most people, the cause of cervical dystonia is idiopathic, or unknown. Researchers have found connections between prior injuries to the head, neck or shoulders, certain gene mutations and a family history to cervical dystonia. Although not often seen, this disorder affects women in middle age more often than men. If a person has dystonia in another part of their body, they may be more likely to get dystonia elsewhere.
Alternative therapies may be useful, such as the use of massage or heat packs to relax sore and tight muscles. Exercise is recommended to keep neck muscles flexible and strong. Some people use sensory tricks, such as touching the opposite side of the head or face from the spasm, to temporarily make the spasm stop. Sometimes rubbing an adjacent area to the one affected may temporarily disrupt the spasm. Each person may find that something different works for them. Unfortunately, as the condition progresses, these quick “fixes” tend to lose their efficacy.
Treatment involves relaxing the muscle spasms by addressing the symptoms, as there is no cure for cervical dystonia. In the past, symptoms were treated with a cocktail of oral anti-spasmodic, anti-depressant and anti-anxiety medications, with varying degrees of success, but with a significant amount of unpleasant side effects.
Thankfully, Botulinum toxin Type A (a paralyzing agent) was developed in the 1980s and in 2001, the FDA approved Type B for those who developed a resistance to Type A. Many people first heard of this medication as Botox®, which certainly revolutionized the cosmetic world as a wrinkle treatment, but now there are several name brands that are in use worldwide. Botulinum Toxin is used today to treat a myriad of medical conditions, from crossed-eye syndrome, to migraine headaches, overactive bladder, overactive sweat glands, muscle spasticity…the list goes on and on. The most effective neurotoxin in the world is a miracle drug as well.
Botulinum toxin injections into the affected neck muscles have proven to be the most effective way we have now of treating the symptoms of cervical dystonia. In fact, over 90% of patients that are treated with botulinum toxin see significant improvement in their symptoms. These injections have to be repeated every three or four months, as the paralytic effect of the toxin wears off. Breakthrough symptoms can still be treated with oral medications, typically muscle relaxants, but possibly anti-depressants or agents that calm the nerves will also be effective.
Cervical Dystonia patients that don’t improve with these treatments will be referred to a Neurosurgeon for a consultation. There is a preferred surgical option for treating cervical dystonia. Deep Brain Stimulation (DBS) uses a pace-maker like battery implanted in the body to deliver an electric current to the part of the brain that controls movement. This low-level current disrupts the brain signals to the muscles that cause the spasms. This surgery has proven more effective than others which have been tried, but is not a panacea for everyone.