What is Cervical Dystonia?
Most experts note cervical dystonia most often happens as the result of another disorder or disease. The condition affects approximately 0.390% of people in the United States or about 390 per 100,000 individuals. Worldwide, cervical dystonia it has been reported in at least 1.2 per 100,000 people each year and on average a person has to visit at least four different doctors before getting a definite diagnosis.
Cervical dystonia can either be primary or secondary, and the condition is focal dystonia which means it generally affects one area of the body. The condition normally occurs in the neck and some people will experience the problem in the shoulders as well. There are two main ways to categorize the disorder; it is either by age of onset (most often occurring in middle age) or cause. Early onset is described as being someone who is diagnosed with the disorder before the age of 27 years old and late onset occurs anytime thereafter. Cervical dystonia is more common in women, rates increase with age and the average age of onset is 41 years old, but most individuals show symptoms between the ages of 50-59 years old.
Cervical Dystonia: Causes
There are two categories of cervical dystonia which are primary and secondary:
- Primary spasmodic torticollis: defined by having no other abnormality other than dystonic movement and an occasional neck tremor, and is generally inherited.
- Secondary spasmodic torticollis: defined as other conditions which can lead to cervical dystonia which can include:
- Perinatal cervical injury
- Central pontine myelinolysis
- Cerebrovascular diseases
- Paraneoplastic syndromes
- Drug induced
- Central nervous system tumors
- Infectious or post-infectious encephalopathies
- Peripheral or central trauma
Secondary spasmodic torticollis is generally diagnosed when there is a history of injury or insult of exposure, due to a neurological abnormality or because of a brain injury. Further classification of the condition depends upon the position of the head and can include rotational collis, laterocollis, anterocollis, retrocollis and a person can have any or all of these combinations.
Signs and Symptoms of Cervical Dystonia
The initial symptoms of cervical dystonia can be mild and it can involve the head turning or tilting in a jerky movement or staying in a certain position involuntarily. Over time and with progression, the involuntary spasms will become more frequent and increase in strength until it reaches a crescendo. The symptoms of the condition can become more profound when a person walks or during periods of increased stress. Other symptoms of cervical dystonia may include muscle hypertrophy, tremors, neck pain and dysarthria, which is a motor speech disorder.
Diagnosing Cervical Dystonia
To make a proper diagnosis of cervical dystonia, a physician will need to obtain a history and physical of the individual. Most often the information supplied by the individual, as well as a physical and neurological examination are the only clues a doctor will have to use because there is no test to confirm the condition and in most cases any laboratory ordered tests will come back inconclusive or normal. At times the condition can be misdiagnosed as arthritis, stiff neck or wryneck, but after considerable observation and an accurate assessment, a physician should rule these things out and be able to pinpoint the disorder.
Treating Cervical Dystonia
There are several different ways in which a physician will treat cervical dystonia, including the following methods:
- Botulinum toxin injections: most commonly used of all treatment methods and involves injecting botulinum toxins into the dystonic muscles which prevents the release of acetylcholine and paralyzes the dystonic muscle.
- Sensory trick: a physical gesture or position which serves as an interruption of dystonia.
- Oral medications: dopamine at low doses can help treat the early stages of cervical dystonia. Other medications used can include anticholinergic agents, clonazepam, baclofen and benzodiazepines.
- Deep brain stimulations: stimulation to the basal ganglia and thalamus has been used and researchers are currently studying implanting a pacemaker-like device subcutaneously with wires going through the skin and into the skull into a particular region of the brain.
- Selective surgical denervation of the nerves which are triggering the condition
Dystonia Awareness Week
The Dystonia Medical Research Foundation has declared the week of June 1st through 7th as Dystonia Awareness Week, in recognition of researching the causes and finding a cure for the disorder. It is thought that by raising awareness through outreach programs and educational information for the public, people will get a better understanding of the disorder and how common the condition has become. Through a yearlong campaign which is capped off by an awareness week, the foundation provides outreach information to those with the disorder.
Members of the medical community together with the general public, join forces to help those in need receive a proper diagnosis, treatment and ongoing support to improve overall knowledge and better the life for those with this mysterious ailment. By raising awareness and providing the public with as much information as possible, it is the hope of the Dystonia Medical Research Foundation that more will become known about the condition, treatment methods will improve and individuals that have the disorder can improve overall quality of life.
Cervical dystonia can be idiopathic in nature or due to some other secondary reasons, but the precise reasons remain a mystery as to why some develop the condition and others do not. With the wide variety of different treatment options, someone suffering from cervical dystonia can find the right way to go about managing the symptoms of the condition and experience a relatively normal, pain free quality of life. It is recommended that people with this disorder follows the orders of a medical professional and avoids doing anything to aggravate or exacerbate the condition. With time and the right treatment the long term prognosis for those with the condition remains positive.