Spasmodic torticollis in adults

Spasmodic torticollis
(G24.3) is a painful intermittent or constant spasm of the neck muscles that causes the head to turn to the side and tilt forward, backward, or sideways. It is observed in women 2 times more often. The average age of a person suffering from this disease is 30-60 years. In the structure of congenital abnormalities, torticollis in newborns ranks third after clubfoot and hip dislocation.

Symptoms

Muscle contractions associated with cervical dystonia can cause the head to rotate in various directions, including:

• Chin tilts towards shoulder
• Ear to shoulder
• Chin goes up
• Chin drops straight down

The most common type of twisting with cervical dystonia is when the chin is pulled towards the shoulder. Some people have a combination of poor head postures. Jerky movements of the head may also occur.

Most patients with cervical dystonia may also experience neck pain that may radiate to the shoulder. The disease can also cause headaches. In some patients with spasmodic torticollis, the pain can be intense and debilitating.

Symptoms of spasmodic torticollis

An experienced vertebrologist can make a preliminary diagnosis of spastic torticollis based on the examination and manual examination. Overstrain of muscles in a certain area, inability to straighten the head, pain in the neck - all these are potential clinical manifestations of the pathology.

But to confirm the diagnosis, a comprehensive examination is required. It begins with an x-ray image, on which, depending on the stage of the pathological process, displacement of the vertebral bodies, the formation of fixing osteophytes and other manifestations can be visible. It is also recommended to conduct an MRI examination, which allows you to visualize the condition of the soft tissues. To exclude the possibility of developing concomitant syndrome of the posterior vertebrogenic artery, an ultrasound scan is performed.

Pay attention to the following symptoms of spasmodic torticollis:

• neck pain and excessive muscle tension on one side or another;
• muscle tension headaches;
• dizziness and loss of coordination of movements;
• a feeling of stiffness in the neck, the inability to make a full turn in one direction or another;
• inability to keep your head straight all the time;
• desire to occupy an unnatural position.

If such signs appear, you should consult a vertebrologist as soon as possible. This doctor will be able to carry out correction using conservative methods of influence. In later stages, the disease can only be successfully treated with surgery.

Causes

In most cases, doctors cannot figure out why some people develop cervical dystonia and others do not. In some cases, however, there is a connection between the development of spasmodic torticollis and injuries to the head, neck or shoulder. Some medications, such as certain psychotropic drugs or antiemetics, may cause cervical dystonia in some people.

Risk factors

Risk factors for developing cervical dystonia include:

• Age. While people of any age can develop the disease, even children, it most often begins between the ages of 40 and 70.
• Floor. Women are more likely to develop spasmodic torticollis than men.
• Family history. If a close family member has cervical dystonia or any other type of dystonia, then the patient has a higher risk of developing the disease.
• Complications: Some people who first develop cervical dystonia go on to develop similar symptoms in neighboring regions, such as the shoulder or face. Additionally, the disability and pain that can be caused by cervical dystonia can lead to depression.

Causes and risk factors

Congenital spastic torticollis in a baby is detected at the moment the baby is born, and its main cause is the incorrect position of the baby’s head during the prenatal period. In some cases, an occupational deviation is observed - acquired torticollis in adults, provoked by pathological processes in the spine and muscles during prolonged forced positioning of the head while performing work duties. The following causes and risk factors for the development of pathology are identified: genetic predisposition; inflammation of the nervous system; neuroinfections; arteriosclerosis of cerebral vessels; intoxication; hepatocerebral dystrophy; birth injury; Huntington's chorea; brain tumors; cerebral paralysis. Spasmodic torticollis often occurs in adults. In children, the disorder is associated with changes in the structure of the sternal or clavicular pedicle of the muscle during intrauterine hypoxia. Spasmodic torticollis in an infant has the following causes: problems with the nervous system; intrauterine hypoxia; trauma during childbirth; keeping the head in one position for a long time. Against this background, the baby may not develop a lesion in the first months. Often the baby begins to turn his head to the side and tilt to one side at 2 months. Gradually, the symptoms intensify, leading to persistent muscle spasm, which complicates treatment. This condition can go away on its own, but in order not to “risk” it is better to treat it.

If the defect is mild, it may remain hidden for some time. The main symptoms of “adult” and infant deviation include: tilting the head to one side and turning the chin to the other; enlargement of the pectoral muscle; deformation of the bones of the skull and sternum; bone changes on x-ray; decreased head mobility; asymmetry of the skull; differences in the location and shape of the ears. With age, the manifestations of the lesions in children increase, and by the age of 4 years they are clearly expressed. When examining the baby from the front, the asymmetry of the neck is noticeable. In extremely rare cases, you can see bilateral torticollis in infants. Treatment of the disease In cases where the cause of the disorder is abnormal growth of bone tissue, neutralizing the deviation can be considered quite successful. Worse, if spastic torticollis in adults is observed due to diseases of the nervous system, then treatment is much more difficult.

Diagnostics

The diagnosis of cervical dystonia (spasmodic torticollis) is made on the basis of characteristic symptoms, examination data and the results of instrumental studies.

The doctor may be interested in answers to the following questions:

• When did the symptoms start?
• Have your symptoms worsened over time?
• What relieves symptoms?
• What medications is the patient taking?
• Have you had a stroke or head injury in the past?

Examination and medical history data help make a preliminary diagnosis of cervical dystonia. But for an accurate diagnosis, it is necessary to exclude other conditions that may have similar symptoms and use additional research methods. Tests may include:

• Blood or urine tests. They can reveal the presence of intoxication.
• Magnetic resonance imaging (MRI). This type of medical imaging may be used to identify and visualize tumors or detect a stroke.
• Electromyography (EMG). This diagnostic method allows the conduction of electrical impulses in the muscles. An EMG helps evaluate and diagnose nerve and muscle conduction disorders and helps confirm the presence of cervical dystonia or another condition.

Acquired torticollis

The acquired variant of torticollis is most often associated with birth injuries, burns, and diseases of the peripheral nervous system. Serious skin problems such as scarring can make it difficult for the baby to turn to one side and can also lead to secondary torticollis, which is called “dermatogenic torticollis.”

Most often, with spastic torticollis in children, the sternocleidomastoid muscle is affected, which turns the head in its direction (left to left, right to right). However, in addition to the muscle itself, the disease involves dysfunction of the entire complex of neck structures, including the spine and skull bones.

When torticollis persists for a long time, the shape of the child’s skull changes, its bones shift, the physiological curves of the spine change, arteries, veins and nerves are compressed, which leads to a wide variety of negative consequences, disrupting the normal development of the child.

Treatment

Spasmodic torticollis cannot be cured. In some patients, symptoms may disappear without treatment, but symptoms often recur. Treatment focuses on reducing symptoms.

Drug treatment

Patients with spasmodic torticollis often need a combination of medications to reduce the intensity of symptoms.

• Botulinum toxin. This medication, which is often used to smooth out facial wrinkles, can be injected directly into the neck muscles that are involved in cervical dystonia. Botulinum toxin is part of such drugs as Botox, Dysport, Xeomin and Myoblock. Most patients with cervical dystonia experience significant improvement after using the toxin, but the effect does not last long and injections of the toxin must be repeated every 3-4 months.
• Drugs for the treatment of Parkinson's disease. Medicines used to combat tremors associated with Parkinson's disease may be used in combination with botulinum toxin injections. Common side effects of these medications include dry mouth, constipation, memory problems, urinary problems, or vision problems.
• Muscle relaxants. These drugs are often not very effective and have side effects, the most pronounced being sedation, impaired motor coordination and mild cognitive impairment. These drugs include diazepam (Valium, Diastat), lorazepam (Ativan), clonazepam (Klonopin) and baclofen (Lioresal, Gablofen).
• Painkillers. The pain associated with cervical dystonia can be quite intense and may require the use of over-the-counter or prescription analgesics.
• Exercise therapy. A carefully selected exercise program can improve neck flexibility and reduce muscle spasm.

In cases where conservative methods (including the use of botulinum toxin) do not produce an effect, surgical treatment methods can be used.

• Muscles or nerves may be cut. Selective denervation is not performed very often.
• Deep brain stimulation (DBS). In this surgical procedure, a thin electrode is inserted into the brain. The tip of the electrode is placed in the part of the brain that controls movement. Electrical impulses are sent through the wire to interrupt the signals from the nerve cells that cause the head to turn. DBS is used only in the most complex cervical dystonia.

Lifestyle

Cervical dystonia is an incurable disease, but by following certain recommendations you can minimize the consequences of this disease:

• Reducing stress. It is necessary to avoid situations that lead to the development of stress or anxiety.
• Get enough sleep and rest. Symptoms often subside during sleep, so it is important to get enough rest. Even short breaks during the workday, during which you can lie on your back and relax, can significantly improve your well-being.
• Use of heat. Heat packs can help loosen tight neck muscles and relieve pain.

Types of spastic torticollis in adults

In adults, there are various types of spastic torticollis. We have already talked about some of them above in the article. This is a classification based on the type of head deviation. Now let’s sort out the classification of types depending on the potential cause of dysfunction of the muscular system.

There are two main forms:

1. spastic muscular torticollis is formed due to constant overstrain of the muscle fiber, regardless of the negative impact of innervation processes (often caused by myositis or fibromyalgia);
2. cervical spastic torticollis - also stems from constant spasm of the muscles of the neck and collar area, but this overstrain is directly related to disruption of innervation processes (compression of the radicular nerves, damage to the nerve plexus, stenosis of the spinal canal).

Dystonia or spastic torticollis against the background of developing osteochondrosis is the most common form of pathology in modern humans. It can be lateral or anteroposterior, depending on which segment of the intervertebral disc is affected.

Symptoms and signs of torticollis

In the first weeks of life, the symptoms of congenital torticollis may not be noticeable to parents. Therefore, it is extremely important not to ignore doctors’ requests and show up for regular checkups. Torticollis cannot be left to chance; the spasmed muscle becomes denser every month until it eventually becomes fibrotic, which will require surgical intervention.

Parents should pay close attention to possible signs of torticollis:

• Slight asymmetry in the baby's movements.
• Rotate the head predominantly in one direction.
• Shoulder shrug.
• Muscle tightness on one side of the neck.

Exercise therapy and massage for muscular dystonia in children will help prevent the appearance of symptoms of torticollis. They can be done at home, provided that the doctor teaches parents in detail and monitors the correct execution.

Ossification of the cervical vertebrae in children lasts up to six months, so children with torticollis who turn to an osteopath after this age are treated longer and more difficult. Regular preventative examinations with an osteopath will help prevent such a turn of events.