Cervical Dystonia

Cervical dystonia (CD) is a type of focal dystonia affecting the neck. Symptoms include pain, muscle spasms and tremors. It is the most common form of focal dystonia with adult-onset. Symptoms usually start between 30 and 50 years of age, and slowly progress during the first 5 years. Remission of symptoms occur in up to 10% of the patients. Many cervical dystonia patients are effectively treated with botulinum toxin injections, and other treatments are available as well.

Type of Dystonia

A type of focal dystonia that affects the muscles of the neck.

Symptoms

  • Neck discomfort
  • Involuntary contractions of the neck muscles
  • Jerky head tremors

Causes

  • Genetics can cause focal dystonia
  • Environmental conditions can trigger focal dystonia
  • Repetitive, skilled and highly trained movements may trigger focal dystonia

Treatment

Regular botulinum toxin injections are the most common form of treatment.

Classification

Focal Dystonia

Other Terms

  • Spasmodic torticollis
  • Torticollis
  • Adult-onset focal dystonia

Based on the position of the neck

  • Torticollis
  • Laterocollis (head tilts to side); 
  • Retrocollis (head tilts back), 
  • Anterocollis (head tilts forward)

 

Cervical dystonia (CD) is the most common form of focal dystonia with adult-onset. The symptoms usually start between 30 and 50 years of age, and slowly progress during the first 5 years. Remission of symptoms occurs in up to 10% of the patients.  

Symptoms

Symptoms start with discomfort in the neck. Involuntary contractions of the neck muscles cause pulling of the head in a particular direction. The shoulder is sometimes involved and elevated. Additionally, jerky head tremors may accompany the condition. A typical feature of cervical dystonia is the sensory trick (also known as guests antagonists) – touching one side of the face to relieve the symptoms of dystonia. Cervical dystonia can be very painful and disruptive in the life of the patient.

Causes

The causes of focal dystonia are still unknown. However, evidence suggests that both genetic and environmental factors may play a role. The exact pathophysiology underlying cervical dystonia remains unclear but there are currently 2 known genes ANO3 and GNAL that are linked to dystonia. Dystonia is in many cases believed to result from a combination of genetic and environmental factors. Additionally, it is possible that repetitive, skilled and highly trained movements may trigger focal dystonia.

Diagnosis

Your doctor will ask about your medical history, mainly :

  • The age of onset 
  • The area of the body affected
  • Whether the condition is getting worse
  • If there are any other clinical problems that could be associated

The doctor will also perform an examination of the affected body part(s). For some patients, blood tests, electromyography or brain scanning may be recommended. It may not be possible for your doctor to find an exact cause of the dystonia, but getting thoroughly examined is the first step in determining and receiving the right treatment.

Treatment

Botulinum Toxin

Botulinum toxic injections are known to be the most effective in the treatment of cervical dystonia. Botulinum toxin injections remain the first-line therapy. Currently, botulinum toxin types A and B have been approved for the treatment of dystonia. What botulinum toxin injections do is temporarily weaken muscles to decrease the spasms and contractions. Injections need to be administered every 3 to 4 months in order to maintain the best results.

Oral Medication

The most commonly used medications include anticholinergics (e.g. Artane -trihexyphenidyl), benzodiazepines, baclofen, muscle relaxants. Medications are oftentimes given on a trial-and-error basis. The key is to balance between the benefits and potential side effects of each particular medication. Common side effects may include dry mouth, drowsiness, anxiety, and difficulty urinating.

Deep Brain Stimulation 

The most invasive treatment is the deep brain stimulation (DBSlectrodes are implanted on the part of the brain that controls the affected muscles. These electrodes are connected to a stimulator that is implanted in your chest. The generator emits electrical signals to help control muscle contractions. This is an efficient treatment option in those patients with cervical dystonia who do not benefit from conservative treatment including local botulinum toxin injections.