brain, spinal cord, and nerve disorders
Cervical Dystonia
Treatment of Cervical Dystonia
Physical techniques Injections of botulinum toxin Sometimes drugs taken by mouth Some physical techniques can sometimes temporarily relieve spasms. Physical therapy may help by improving flexibility. Therapists may also help people identify which movements worsen spasms and which ones relieve them. Biofeedback (using relaxation techniques to control unconscious body processes, such as heart rate and muscle tension) or massage may help some people. People may find certain tricks that may briefly relieve spasms. They include lightly touching the chin, cheek, upper face, or back of the head. These tricks are usually more effective if done on the side opposite the spasm. When an emotional problem contributes, treatment is best managed by a team of doctors, including a psychiatrist, a psychologist, and a neurologist. In about 70% of people with cervical dystonia, injections of botulinum toxin into the affected muscles can reduce painful spasms for 1 to 4 months and allow the head to return to a more normal position. However, for continuous relief, injections must be repeated every 3 to 4 months because the benefit of botulinum toxin wears off over time. In a few people who are repeatedly given to botulinum injections, the body produces antibodies that inactivate the toxin. If the affected muscles are tiny or deep in the body, Electromyography and Nerve Conduction Studies (stimulating muscles and recording their electrical activity) may be done to identify the muscles to be injected. Certain drugs, given by mouth, may help, but they control the spasms in only about 25 to 33% of people. These drugs include Anticholinergic: What Does It Mean? drugs, such as A benzodiazepine (a sedative), particularlyclonazepam Baclofen(a muscle relaxant) Carbamazepine(an antiseizure drug) Anticholinergic drugs are given for their effects, which can lessen spasms. However, these drugs also have other, troublesome side effects (such as confusion, drowsiness, and dry mouth), which may limit their use. All of these drugs are started in low doses. Doses should be increased until symptoms are controlled or side effects cannot be tolerated. Side effects from these drugs are particularly likely in older people. The role of surgery involving areas outside the brain is controversial. For example, in one such procedure, the nerves to the affected muscles are cut. As a result, the nerves can no longer stimulate the muscle to contract. However, after this procedure, the muscles are permanently weakened or may be paralyzed. When the procedure is done by skilled surgeons, benefits outweigh potential complications. If symptoms are severe and all of the usual treatments have been ineffective, deep brain stimulation can be done. For this procedure, tiny electrodes are surgically implanted in part of the basal ganglia (collections of nerve cells that help initiate and smooth out voluntary muscle movements). The electrodes send small amounts of electricity to the specific area of the basal ganglia that causes cervical dystonia and thus help lessen symptoms. 