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 Cervical dystonia

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PostSubject: Cervical dystonia    Cervical dystonia  EmptyThu Jan 20, 2011 11:14 am

Cervical dystonia

Filed under: Boomer's Health

Cervical dystonia, also called
spasmodic torticollis, is a painful condition in which your neck muscles
contract involuntarily, causing your head to twist or turn to one side.
Cervical dystonia can also cause your head to uncontrollably tilt
forward or backward.




A rare disorder that can occur at
any age, even infancy, cervical dystonia most often occurs in
middle-aged people, women more than men. Symptoms generally begin
gradually and then reach a point where they don't get substantially
worse.




There is no cure for cervical
dystonia. The disorder sometimes resolves without treatment, but
sustained remissions are uncommon. Injecting botulinum toxin into the
affected muscles often reduces the signs and symptoms of cervical
dystonia. Surgery may be appropriate in a few cases.






Symptoms



The muscle contractions involved in cervical dystonia can cause your head to twist in a variety of directions, including:



* Chin toward shoulder

* Ear toward shoulder

* Chin straight up

* Chin straight down



The most common type of twisting
associated with cervical dystonia is when your chin is pulled toward
your shoulder. Some people experience a combination of abnormal head
postures. A jerking motion of the head also may occur.




Most people who have cervical
dystonia also experience neck pain that can radiate into the shoulders.
The disorder also can cause headaches. In some people, the pain from
cervical dystonia can be exhausting and disabling.






Causes



In most cases of cervical dystonia,
doctors don't know why some people develop the disorder and others
don't. Some cases, however, appear to be linked to:




* Head, neck or shoulder injuries

* Certain drugs, notably specific antipsychotic or anti-nausea agents





Risk factors



Risk factors for cervical dystonia include:



* Age. While the disorder can
occur in people of any age, even children, it most commonly begins
between the ages of 40 and 70.


* Sex. Compared with men, women are nearly twice as likely to develop cervical dystonia.

* Family history. If a close
family member has cervical dystonia or some other type of dystonia, you
are at higher risk of developing the disorder.






Complications



Some people who start out with
cervical dystonia eventually develop similar symptoms in neighboring
regions, such as the shoulder or face. However, cervical dystonia in
middle age does not expand to wide areas of the body, as may occur in
children.




The disability and pain that can be caused by cervical dystonia may result in depression.





Preparing for your appointment



While you might first discuss your
symptoms with your family doctor, he or she may refer you to a
neurologist — a doctor who specializes in disorders of the brain and
nervous system — for further evaluation.




What you can do

Because appointments can be brief, plan ahead and write a list that includes:



* Detailed descriptions of your symptoms, including when they started and if anything makes them better or worse

* Information about medical problems you've had in the past, such as strokes or head injuries

* Information about the medical problems of your parents or siblings

* All the medications and dietary supplements you take

* Questions you want to ask the doctor



What to expect from your doctor

In addition to conducting a physical exam, your doctor may also check your neurological health by testing your:



* Reflexes

* Muscle strength

* Muscle tone

* Senses of touch and sight

* Coordination

* Balance





Tests and diagnosis



While the physical examination
alone can often confirm a diagnosis of cervical dystonia, it's important
to determine if there are underlying conditions causing your signs and
symptoms. Tests may include:




* Blood or urine tests. These may reveal the presence of toxins.

* Magnetic resonance imaging
(MRI). This type of imaging test may be used to identify and visualize
tumors or evidence of stroke.


* Electromyography (EMG). This
test measures the electrical activity of muscles. EMG helps evaluate and
diagnose muscle and nerve disorders and can help confirm whether you
have cervical dystonia or another condition.






Treatments and drugs



There is no cure for cervical
dystonia. In some people, signs and symptoms may disappear without
treatment, but recurrence is common. Treatment focuses on relieving the
signs and symptoms.




Medications

People who have cervical dystonia often must use a combination of medications to reduce their signs and symptoms.



* Botulinum toxin. This
paralyzing agent, often used to smooth facial wrinkles, can be injected
directly into the neck muscles affected by cervical dystonia. Most
people with cervical dystonia see an immediate improvement with this
treatment, which usually must be repeated every three to four months.


* Parkinson's drugs.
Medications used to combat the tremors associated with Parkinson's
disease, including trihexyphenidyl and benztropine (Cogentin), may be
used in combination with botulinum toxin injections. Frequent side
effects include dry mouth, constipation, memory problems, reduced
urinary stream or visual blurring.


* Muscle relaxants. These drugs
often help a little, but also have side effects, most notably sedation,
imbalance and mild cognitive impairment. Examples include diazepam
(Valium, Diastat), lorazepam (Ativan), clonazepam (Klonopin) and
baclofen (Lioresal).


* Pain medications. The pain
from cervical dystonia may require drug treatment. This may range from
over-the-counter pain relievers to prescription pain medications.




Therapy

The signs and symptoms of cervical dystonia are sometimes eased by:



* Exercises that improve neck strength and flexibility

* Judicious use of a neck brace

* Training in stress management techniques



Surgical and other procedures

If less invasive treatments don't help, your doctor may suggest surgery.



* Cutting muscles or nerves.
Surgery to cut the nerves or muscles responsible for the contorted
posture associated with cervical dystonia can be performed to help those
who no longer get benefit from botulinum toxin or medications. This is
called selective denervation surgery and isn't widely available.


* Deep brain stimulation (DBS).
In this surgical procedure, a thin, insulated wire into the brain
through a small hole cut into the skull. The tip of this electrode is
placed in the portion of the brain that controls movement. The electrode
is connected, via a wire that passes under the skin, to a small battery
pack in your chest. The battery pack is about the size of a pocket
watch, and it sends electrical pulses to the electrode to interrupt the
nerve signals making your head twist. DBS is used only in the most
difficult of cervical dystonia cases.






Lifestyle and home remedies



Cervical dystonia has no cure, but you can do a number of things to minimize its effects:



* Reduce stress. Avoiding
situations that cause stress or anxiety is important because stress
tends to make your signs and symptoms worse.


* Get your rest. Signs often
disappear during sleep, so get plenty of rest. You may find relief by
taking short breaks during your day to lie on your back and relax.


* Use heat. Heat packs may help loosen the taut muscles in your neck and help with pain relief.

* Try touching. Sensory tricks,
such as touching the opposite side of your face or the back of your
head, may cause spasms to stop temporarily. Different sensory tricks
work for different people, and if you find one that works, it usually
will continue to work for you.






Alternative medicine



Some types of alternative medicine
techniques may help the medications prescribed to treat cervical
dystonia work better or for longer periods of time. For example, massage
or other strategies that tend to relieve muscle tension may be tried.






Coping and support



Severe cases of cervical dystonia
may make you feel uncomfortable in social situations or even limit your
abilities to accomplish everyday tasks such as driving. Many people with
cervical dystonia feel isolated and depressed.




Remember that you're not alone. A
number of organizations and support groups are dedicated to providing
information and support for you and your family — whether you have the
disorder or you have a friend or family member who does.




Your doctor may be able to suggest
support groups available in your area, or there are a number of good
sites on the Internet with information about local support groups.




©



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