Cervical dystonia, also known as spasmodic torticollis, is a side effect which causes neck muscles to contract on their own. This causes abnormal movements and abnormal posture of the head and neck. The abnormal movements can be constant, jerky or a combination of both. Cervical dystonia can be caused by the treatments used for head and neck cancers, including radiation and surgery and is the result of muscle and/or motor nerve damage.
Cervical dystonia can lead to pain in the neck and shoulders, muscle stiffness, spasms, and a change in posture. These spasms can cause the head to tilt to the side, backwards or forward. Cervical dystonia can lead to increased challenges in performing activities of daily living.
How is it treated?
There are a variety of treatments for cervical dystonia all with varying degrees of success. None of these treatments will cure cervical dystonia. These include:
- Sensory tricks: Some patients find that actions such as touching the opposite side of your face or chin can temporarily cause the spasms to stop. This may be effective early on, but tend to lose effectiveness as the dystonia progresses.
- Medications: Dopamine blocking medications have been used, but cause serious side effects such as sedation and Parkinson-like movements. Anti-cholinergic medications, including gabapentin, are more commonly used, but these can also cause side effects.
- Injections of botulinum toxin (Botox): Research has found botulinum toxin to be the most effective treatment. Botulinum toxin is a neurotoxin that prevents the nerve from releasing acetylcholine, which is a neurotransmitter that tells the muscle to contract. It is injected directly into the affected muscles, weakening the muscle and helping the muscles to relax, resulting in better controlled movement of the neck and shoulders. The dose and how often you need injections will be determined by your provider.
- Physical therapy: Physical therapy can be used to stretch the muscles and mobilize the soft tissues in the neck, which increases mobility and decreases pain.
- Surgery: Deep brain stimulation is the placement of electrodes into the brain. These send electrical impulses into the brain which improves the dystonic movements.
In some cases, cervical dystonia can resolve on its own but it is important to notify your provider if you feel that you are experiencing cervical dystonia. Together you can determine a treatment plan.
Contarino MF et al. Clinical Practice: Evidence- based recommendations for the treatment of cervical dystonia with botulinum toxin. Frontiers in Neurology. 2017. Found at: http://journal.frontiersin.org/article/10.3389/fneur.2017.00035/full
Dystonia Medical Research Foundation. Found at: https://www.dystonia-foundation.org/what-is-dystonia/forms-of-dystonia/focal-dystonias/cervical-dystonia/more-on-cervical-dystonia
National Organization for Rare Disorders. Cervical Dystonia. 2016. Found at: https://rarediseases.org/rare-diseases/cervical-dystonia/