Cervical Dystonia

Cervical dystonia, also known as “spasmodic torticollis,” is a side effect that causes your neck muscles to contract (tighten) on their own. It causes abnormal movements and posture of your head and neck. The abnormal movements can be constant, jerky, or a mix of both.

Cervical dystonia can be caused by treatments used for head and neck cancers, like radiation and surgery. It is caused by damage to the muscles and motor nerves (nerves that carry signals from the central nervous system to muscles and glands).

What are the signs and symptoms?

Symptoms start slowly. Cervical dystonia can cause:

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

Spasms can cause your head to tilt to the side, backward, or forward. Cervical dystonia can make it hard to do your daily activities.

How is it treated?

There is no cure for cervical dystonia, but symptoms can be treated with these methods:

• Sensory tricks: You may find that certain actions, like touching the opposite side of your face or chin can cause the spasms to stop for a short time. This may help early on, but it tends to not work as well as the dystonia gets worse.
• Medications: There is no medication that works for everyone, but a few medications have been shown to help symptoms. The types of medication used are:
  • Anticholinergics: Block a neurotransmitter chemical that controls muscle spasms.
  • Benzodiazepines: Act like a muscle relaxant that stops nerve signals to your brain and spinal cord.
  • Baclofen: Acts as a muscle relaxer.
  • Dopaminergic  Agents: Increase levels of dopamine, a neurotransmitter.
  • Tetrabenazine: Decreases dopamine and is used to treat some movement disorders. This is 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, a neurotransmitter that tells muscles to contract (tighten). It is injected directly into the affected muscles, weakening the muscles and helping them to relax. This leads to better-controlled movement of your neck and shoulders. The dose and how often you need injections will be decided by your provider.
• Non-drug therapies: You may need physical (PT), occupational (OT), speech and/or voice therapy. Physical therapy can be used to stretch the muscles and relax 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 signals into the brain to improve the dystonic movements.

Each person responds differently to treatment. In some cases, cervical dystonia can get better on its own, but it is important to let your provider know if you have any of the symptoms of cervical dystonia. Together you can decide on a treatment plan that is right for you.