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Cervical Dystonia: Symptoms, Causes, Diagnosis & Treatment

Cervical dystonia, also termed as spasmodic torticollis, is a neurological movement disorder .[1] The disorder causes involuntary movements in your neck, that is, it causes the neck to turn to the left, right, upwards and downwards. The condition causes extreme pain to your neck muscles and restricts one from carrying out the daily activities due to the discomfort it causes.

The primary neurological disorder begins slowly and then gets worse with time. In most cases, cervical dystonia [2] stabilises after a period of time. The abnormal contractions can be sustained or continuous, and in severe cases, it can resemble a tremor.

Cervical dystonia and its severity vary from one individual to the other. That is, while some may suffer from a minor tremor, others could end up experiencing postural abnormalities[3] that are severe. Middle-aged women are increasingly prone to develop the condition than men, however, it can also develop during infancy.[4] In rare cases, it can develop as a result of any disease or another disorder.

Symptoms Of Cervical Dystonia

The contractions in the neck muscle appear on a slow pace and can affect any muscle. The symptoms[5] usually appear between the ages of 20 and 60, and in some cases, it has been reported between the ages of 30 and 50.

Cervical dystonia is comprised of various symptoms such as [6]

• pulling of the chin towards the shoulder (which is the most common symptom),

• turning of the ear towards the shoulder,

• burning pain in the neck and shoulders,

• severe headaches,

• speech difficulties,

• uncontrollable blinking,

• foot cramping,

• chin being pulled straight up and down, and

• severe neck pain that can radiate towards the shoulders.

Usually, the symptoms can disappear within a period of four to five years. The mild spasms developing at a young age are likely to disappear quickly. But, in the case of the signs persisting for a longer period of time, it can permanently twist the neck, shoulders and head into a distorted position and restrict the ease of movement.[7]

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Causes Of Cervical Dystonia

The specific reason why an individual develops the condition is not known clearly. Cervical dystonia is understood to be caused as a result of some issue with the basal ganglia, the part of the brain that is responsible for muscle contractions.[8]

• In some cases, cervical dystonia is caused in individuals who have a family history[9] of the disorder. Here, a genetic component could be understood as the factor.

• In other cases, the condition can develop as a result of underlying reasons such as shoulder, neck or head injuries.[10] [11]

Secondary cervical dystonia [12] occurs when other conditions lead to the neurological movement disorder. From diseases to external factors, various secondary causes can accord to the development of the condition.

Secondary cervical dystonia can develop due to various conditions such as [13]

• central pontine myelinolysis,

• perinatal cerebral injury [14] ,

• paraneoplastic syndromes,

• kernicterus,

• cerebrovascular diseases,

• infectious or post-infectious encephalopathies[15] ,

• induced by drugs,

• central nervous system tumour [16] ,

• peripheral or central trauma, and

• toxins.

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Risk Factors Of Cervical Dystonia

Family history [17] : If one of your close relatives in the family has cervical dystonia or any other type of dystonia, your chances of developing the condition are high.

Sex: Women [18] are more likely to get affected by the condition than men.

Age: Although individuals can develop the neurological movement disorder at any time, your chances of developing the condition is high if you are more than 30 years old.[18]

Complications Of Cervical Dystonia

There have been reports of cases where the involuntary and uncomfortable muscle contractions have spread to other parts of the body. It mostly spread to the jaw, trunk, arms and face.[19]

Complications such as bone spurs [20] can develop, which will result in reducing the space in your spinal canal. The reduction of space can cause numbness, tingling and weakness in the legs, arms, feet and hands.

Diagnosis Of Cervical Dystonia

In order to examine the neurological movement disorder, the doctor will carry out a physical examination and a patient history check. This will help the doctor gain some knowledge about your condition. During the physical examination, the doctor will examine the position of the head. This is done so as to understand whether it is retrocollis, anterocollis, laterocollis or torticollis.[16]

The doctor may suggest an MRI (Magnetic Resonance Imaging)[21] or a blood test to examine and ensure that the signs and symptoms are not a reflection of any other conditions.

A urine test [22] will be done to examine whether the condition is caused as a result of toxins, which will be visible through the urine sample.

Electromyography (EMG) [23] will aid in diagnosing any disorder in the nerves or muscles. EMG will measure and analyse the electrical activity in your muscles, thereby helping the doctor confirm the root of the cause.

Treatments For Cervical Dystonia

In some cases, the signs and symptoms have disappeared without the intervention of any medication. As there is no definite cure for the neurological involuntary disorder, the treatments will help in reducing and limiting the onset of symptoms.[24]

1. Therapy

Under this treatment method, the doctor will use sensory tricks. That is, touching the back side of your head or opposite side of your face. This will help in temporarily stopping the spasm. But, sensory tricks can lose effectiveness with time and work differently on individuals .[25]

Massages and heat packs can help reduce the discomfort and relax your shoulder and neck muscles. Neck exercises that improve the strength and flexibility may also help.[26]

Stress relief exercises [27] can also be adopted.

2. Medications

A paralysing agent termed as Botulinum toxin[28] has become the go-to treatment measure for cervical dystonia. Botulinum toxin is usually used for smoothing the facial wrinkles. The medicine is directly injected into the muscle affected by the disorder.

Usually effective, the injections are to be repeated every three to four months.[29]

3. Surgery

In elevated situations, the only option to get some relief from the discomfort is to undergo surgery. If your cervical dystonia symptoms cannot be relieved with the above-mentioned methods, the doctor may ask you to undergo surgery.[30]

The two options of surgery are deep brain stimulation [31] and cutting the nerves. In deep brain stimulation, a thin-sized wire is inserted into your brain through a small hole/cut, into the brain. The tip of the wire will be placed where the controlling part of the brain is located. Then, electrical pulses will be sent into your brain to interrupt the nerve signal causing the twists and twitches.

The other option is surgically removing the nerves that carry the contraction signals to the muscles that are affected by the dystonia.[32]

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