Cervical Dystonia

Cervical dystonia, also known as spasmodic torticollis, is a side effect that causes your neck muscles to contract on their own. It 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. It is the result of muscle and/or motor nerve damage.

What are the signs and symptoms?

Symptoms start slowly and may get worse before stabilizing. Cervical dystonia can lead to:

• Pain in the neck and shoulders.
• Muscle stiffness.
• Less range of motion.
• A change in posture.
• Spasms.

These spasms can cause the head to tilt to the side, backward, or forward. Cervical dystonia can make daily activities more challenging.

How is it managed?

There is no cure for cervical dystonia, but symptoms can be managed using a combination of these methods:

• Sensory tricks: You may 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 tends to lose effectiveness as the dystonia progresses.
• Medications: Not one medication works for everyone, but several medications have been shown to manage symptoms. These medications can cause side effects. The categories of medication that are commonly used are:
  • Anticholinergics: Acts by blocking a neurotransmitter chemical, that controls muscle spasms.
  • Benzodiazepines: Act like muscle relaxants, which stop nerve signal transmission in the brain and spinal cord.
  • Baclofen: Acts as a muscle relaxer.
  • Dopaminergic Agents: Medication that increases the neurotransmitter dopamine.
  • Tetrabenazine: Medication that decreases dopamine and is used to treat some movement disorders. Used in rare cases.
• Injections of botulinum toxin (Botox): Botulinum toxin is the most common treatment. It 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.
• Non-drug therapies: These include physical, occupational, speech and/or voice therapy, as well as relaxation and stress management. 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 (DBS) is the placement of electrodes into the brain. These send electrical impulses into the brain which improves the dystonic movements.

Each person responds differently to treatment. 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.