Cervical Dystonia

Cervical dystonia (spasmodic torticollis) is a neurological disorder causing involuntary, painful contractions of the neck muscles. This leads to the head twisting, turning, tilting, or jerking uncontrollably. While there is no cure, various treatments can help manage symptoms, reduce pain, and improve head position and quality of life.

What is Cervical Dystonia?

Cervical dystonia, also known as spasmodic torticollis, is a neurological condition where the neck muscles contract involuntarily and often painfully. These uncontrolled muscle spasms cause the head to twist, turn, tilt forward or backward, or jerk to one side. It is a type of dystonia, which is a movement disorder.

Cervical dystonia specifically affects the muscles in your neck. These muscles can contract for a short time (spasmodic) or stay contracted for longer periods (sustained). This can pull your head into unusual and sometimes uncomfortable positions. The condition can affect anyone, but it often begins in middle age. It is considered a chronic (long-lasting) condition, meaning it usually continues throughout a person's life. While the exact cause is often unknown, treatments are available to help manage the symptoms and improve your daily life.

Symptoms

The main symptom of cervical dystonia is involuntary head movements, where your head twists, turns, tilts, or jerks uncontrollably. This often comes with neck pain, which can be constant or intermittent and may spread to your shoulders. Symptoms can vary in severity and may worsen with stress or certain activities.

The involuntary movements can cause your head to be pulled to one side, forward (anterocollis), backward (retrocollis), or tilted sideways (laterocollis). These movements can be sustained, meaning your head stays in an abnormal position, or they can be jerky and repetitive. Many people with cervical dystonia experience significant pain in their neck, which can extend to their shoulders and cause headaches. Some also develop a tremor in their head or experience one shoulder being pulled higher than the other. Interestingly, some individuals find that touching the affected side of their face or the back of their head can temporarily relieve the spasms. This is known as a "sensory trick" or "geste antagoniste." Symptoms can fluctuate, sometimes improving for a period, but they usually return.

Causes & risk factors

In most cases, the exact cause of cervical dystonia is unknown, which is called idiopathic. However, it can sometimes be linked to other conditions like brain injury, stroke, or certain medications. Genetic factors may also play a role, as the condition can run in families in some instances.

When the cause is unknown, it is thought to involve problems in the basal ganglia, a part of the brain that helps control muscle movement. These problems lead to incorrect signals being sent to the neck muscles, causing them to contract abnormally. In some cases, cervical dystonia can be a secondary condition, meaning it develops as a result of another underlying issue. These can include head or neck injuries, stroke, tumors, or certain infections. Some medications, particularly those used to treat nausea or psychiatric conditions, can also trigger dystonia as a side effect. While a family history of dystonia can increase your risk, most people with cervical dystonia do not have a clear genetic link. The condition typically appears in middle age, affecting women more often than men, though it can occur at any age.

How it's diagnosed

Diagnosing cervical dystonia primarily involves a thorough physical and neurological examination by a doctor. There isn't a specific test to confirm the condition. Instead, your doctor will assess your symptoms and movements and may order tests like MRI or blood work to rule out other conditions that could cause similar symptoms.

During the examination, your doctor will observe your head and neck movements, check your muscle strength, and assess your reflexes. They will ask about your medical history, including any medications you are taking, and when your symptoms started and how they have progressed. To ensure your symptoms are not caused by another condition, your doctor might recommend imaging tests such as a magnetic resonance imaging (MRI) scan or a computed tomography (CT) scan. These scans can help rule out structural problems in your brain or neck, such as tumors, stroke, or spinal cord issues. Blood tests may also be performed to check for other conditions that can mimic dystonia, such as certain metabolic disorders or infections. The diagnosis of cervical dystonia is often made by carefully evaluating your symptoms and excluding other possible causes.

Treatment options

Treatment for cervical dystonia focuses on managing symptoms, reducing pain, and improving head position, as there is no cure. The most common and effective treatment involves injections of botulinum toxin into the affected neck muscles. Other options include oral medications, physical therapy, and, in severe cases, surgery.

**Botulinum toxin injections** are considered the first-line treatment for most people. A doctor injects small amounts of botulinum toxin (like Botox, Dysport, or Xeomin) directly into the overactive neck muscles. This toxin temporarily blocks nerve signals to the muscles, reducing spasms and pain. The effects typically last for about three to four months, after which repeat injections are needed. Potential side effects can include temporary neck weakness, difficulty swallowing (dysphagia), or dry mouth. **Oral medications** may be prescribed, often in combination with botulinum toxin injections. These can include muscle relaxants (like baclofen or tizanidine), anticholinergic drugs (like trihexyphenidyl), or certain tranquilizers (like clonazepam). While these medications can help some people, their effectiveness for cervical dystonia is limited, and they often come with side effects such as drowsiness, dry mouth, or memory problems. **Physical therapy** can be a helpful addition to other treatments. A physical therapist can teach you exercises to stretch and strengthen your neck muscles, improve your posture, and reduce pain. Techniques like heat or cold therapy, massage, and biofeedback may also provide relief. For severe cases that do not respond to other treatments, **surgery** might be considered. Options include deep brain stimulation (DBS), where electrodes are implanted in the brain to send electrical pulses that help control movement. Another surgical option is selective denervation, which involves cutting specific nerves that supply the overactive muscles. These are typically reserved for individuals with significant disability.

Recovery & outlook

Cervical dystonia is generally a chronic, lifelong condition, meaning it usually does not go away completely. While symptoms can fluctuate in severity, treatment aims to manage pain, improve head posture, and enhance your quality of life. Spontaneous remission, where symptoms disappear on their own, is rare, occurring in about 1 to 2 out of 10 people (10-20%).

For most individuals, cervical dystonia requires ongoing management. The goal of treatment is not to cure the condition but to reduce the severity of muscle spasms and associated pain. This allows you to maintain better head control and participate more fully in daily activities. Even with effective treatment, symptoms may not disappear entirely, but they can become much more manageable. It's important to work closely with your healthcare team to find the most effective combination of therapies for your specific needs. Adjustments to medications or injection sites may be necessary over time. While spontaneous remission is uncommon, when it does occur, it usually happens within the first five years of symptom onset. However, even after remission, symptoms can sometimes return. Living with cervical dystonia often involves adapting to the condition and focusing on symptom relief and maintaining a good quality of life.

When to see a doctor

You should see a doctor if you experience persistent or worsening involuntary head movements, neck pain, or stiffness. It's important to seek medical advice for any new or unusual symptoms affecting your head and neck, as early diagnosis and treatment can help manage the condition and improve your quality of life.

If you notice your head twisting, turning, or tilting uncontrollably, or if you develop chronic neck pain that doesn't improve, consult your primary care doctor. They can evaluate your symptoms and refer you to a neurologist, a doctor specializing in brain and nervous system disorders, for further assessment. It is especially important to seek prompt medical attention if your symptoms are severe, rapidly worsening, or if they are accompanied by other concerning signs like difficulty swallowing, breathing problems, or weakness in other parts of your body. These could indicate a more serious underlying condition.

Frequently asked questions

Can cervical dystonia be cured?

No, cervical dystonia is generally a chronic condition with no known cure. Treatment focuses on managing symptoms, reducing pain, and improving head position and quality of life. In rare cases, about 1 to 2 out of 10 people (10-20%) may experience spontaneous remission, where symptoms temporarily disappear.

Is cervical dystonia painful?

Yes, cervical dystonia is often a painful condition. The involuntary muscle contractions in the neck can cause significant discomfort, which may range from mild to severe. This pain can also radiate to the shoulders and lead to headaches.

What is the "sensory trick" for cervical dystonia?

A "sensory trick," also known as a "geste antagoniste," is a specific touch or gesture that can temporarily relieve the muscle spasms in cervical dystonia. For example, lightly touching the chin, cheek, or the back of the head may help reduce the involuntary head movements for a short time.

How often are botulinum toxin injections needed?

Botulinum toxin injections are typically needed every three to four months. The effects of the toxin gradually wear off, and repeat injections are necessary to maintain symptom relief and manage the muscle spasms effectively. Your doctor will determine the best schedule for you.

Can stress make cervical dystonia worse?

Yes, stress and anxiety can often worsen the symptoms of cervical dystonia. Many individuals report that their involuntary muscle spasms and pain become more pronounced during periods of emotional stress or fatigue. Managing stress through relaxation techniques may help.

Is cervical dystonia a sign of a more serious brain problem?

In most cases, cervical dystonia is idiopathic, meaning its cause is unknown and it's not a sign of a life-threatening brain problem. However, doctors will often perform tests like MRI scans to rule out other conditions such as tumors, stroke, or structural abnormalities that could cause similar symptoms.

Sources

• MedlinePlus — Cervical Dystonia
• Mayo Clinic — Cervical Dystonia
• Cochrane Library — Cervical Dystonia