Spasmodic Torticollis Is A Neurological Condition Of The Brain Affecting Neck Muscles.
Spasmodic torticollis, features contractions or spasms of neck muscles that are not under ones control. These spasms forcefully alter head position and can greatly interfere with life activities as well as the quality of life.
Spasmodic Torticollis, a type of cervical dystonia, causes the muscles of the neck contract uncontrollably, making the head turn into various postures. The spasms tend to worsen when a person stands or walks and can make simple tasks quite difficult.
What Are The Causes?
Spasmodic Torticollis is thought to originate in a part of the brain called the basal ganglia. A disturbance in the balance of chemicals produced in the brain may be responsible. One of these chemicals known as Acetylcholine may be affected. The neurotransmitters or chemical messengers secreted from the basal ganglia travel through nerve pathways to certain muscles of the neck. The increased nerve signals cause spasms to occur which cause the head to be pulled.
An accident, or a trauma of some kind, can trigger its onset. In approximately 50% of the spasmodic torticollis population, there is a family history of hand or head tremors.
What Are The Symptoms?
The main neck muscles that are most prominently involved, are the sternocleidomastoid, trapezius, levator scapulae and splenius capitis. On occasion, when the muscles in the neck contract, they can cause tightness and contractions in the whole body.
The pain may become worse and, in many cases, severe. Symptoms will generally settle on one side of the neck; a shoulder may be higher; pain, numbness or tingling sensations may be felt in the arm or hand. At least two-thirds of the individuals additionally have neck pain which radiates into the shoulders. It can also trigger headaches which are. For some, this condition is not only painful, but exhausting as well as disabling. If tremors are present, they will generally be in the head.
Symptoms of spasmodic torticollis typically start in those from 30 to 50 years of age, but can start at any age and affects women more than men. Onset may be gradual or it may come on suddenly. The involuntary contractions can be painful and primarily on one side, causing the head to be in an abnormal posture, depending on the muscles involved. For instance, the sternocleidomastoid muscle will cause the head to turn away from the side of contraction and bend to the opposite side. Torticollis refers to the rotating motion, however, according to the muscles involved, the condition is called according to the primary posture it produces. If the head is mostly tilted to the side, it is called laterocollis, to the front – anterocollis, and to towards the back – retrocollis.
During sleep, the condition usually will disappear.
A 2023 study in Neurological Sciences found patients showed dysfunctions in controlling dynamic body location during walking, which could lead to an improper body position awareness.
How Is It Diagnosed?
Spasmodic torticollis can be mild, moderate or severe and will slowly progress during 1 to 5 years and then levels off. Within 5 years, 10 to 20 percent of individuals experience a spontaneous recovery, however, this is most often noticed with mild levels of symptoms and with onset at earlier ages. In more severe cases, it can last throughout life, causing movement restrictions and even altered posture.
The condition may first be diagnosed by a family physician, however, referral is usually made neurologist for definitive diagnosis and treatment.
Be prepared for a doctor visit:
- Have a thorough description about the symptoms, when it started and what makes it worse or better
- Past medical conditions, including stroke or head injury
- Family history, medical conditions of siblings or parents
- Medicines and supplements you are taking
- Prepare questions you may have
An examination will be performed which may include balance/coordination, touch/sight, muscle tone/strength, reflexes and it may include motions which can trigger spasms like opening and closing your fists quickly and repeatedly. Additional testing may include blood/urine samples to check for toxins, MRI scans to check for stroke or tumor and electrical muscle testing (EMG) to check the nerves and muscle function.
- According to the Journal of the American Board of Family Medicine therapies include behavior modification, like biofeedback, hypnosis, or training in consciously readjusting the position of the head. Pharmacotherapy use a variety of agents, most commonly anticholinergic medications or the botulinum toxin type A. Surgery is an option if other methods do not work, which uses selectively denervating of the muscles responsible for abnormal movement or head posture.
What Medicines Can Help
Individuals suffering from spasmodic torticollis may need combinations of medicines to help alleviate the symptoms.
1) Botulinum toxin. Most commonly known as Botox for cosmetic rejuvenation, it can be injected into the involved muscles to cause a temporary paralysis of the muscles, lasting about 4 months.
2) Parkinson’s Medications. These help reduce tremors and can be combined with botulinum injections.
3) Muscle Relaxers. When stress is a factor which increases spasms, medications like Valium, Ativan and Clonazepam may help.
If the above methods fail to provide relief, surgery may be recommended.
Brain Stimulation. A small wire is inserted in the brain which connects to a small battery power source under the skin in the chest. This can help alter signals that the neck muscles receive from the brain to reduce involuntary contractions.
Denervation. This involves cutting nerves or muscles to disrupt signals and muscle function in order to achieve relaxation of spasms.
Physical Therapy. Stretches and strength building exercises can have a positive effect on the resulting postural problems and may assist in the alleviation of pain, enhancing the effects of medications.
Stress reduction. Stress and anxiety can aggravate symptoms, so learning to manage stress is important. Biofeedback techniques may help.
Resting. Because spasms usually go away when sleeping, getting sufficient amounts of rest can help. Taking breaks during the day to lie down and rest can promote relaxation of spasms. Massage therapy sessions may also help relax muscles and promote resting.
Sensory Techniques. Different techniques like touching different areas on the face or head may alter the muscle spasms. This is usually by trial and error to find what works for an individual, but a knowledgeable physical therapist can help with these techniques.
Find spasmodic torticollis support groups in your local area or on the internet.