What is cervical dystonia

Unfortunately, cervical dystonia is very commonly misdiagnosed and patients may see five providers before getting a proper diagnosis. Typically treatment is effective for the head tilt and tremor, but for patients who still have symptoms, there are a few day to day approaches that can help. One is called a sensory trick — a light touch to the chin, or back of the head, temporarily reduces the dystonia.

This is not meant to be a rough forced movement, just a sensory reminder to alleviate the symptoms for a moment. Many patients find sitting in a high-backed chair more comfortable than a chair without neck support. In terms of social embarrassment, it really depends on the situation whether patients wish to divulge the cause of the head shaking or not. Neck sprains are very common and may cause a temporary abnormal posture with associated pain. Massage and stretching will help for these and they typically resolve in a few days or weeks.

Cervical dystonia is usually lifelong, even though it does not begin until middle age commonly. Cervical dystonia comes from the brain sending abnormal signals to the muscles, resulting in an incorrect set point. Neck sprains, sometimes called cervical sprain or muscle sprain, come from the muscles.

Does physical therapy help treat cervical dystonia? It depends on the familiarity of the therapist with the diagnosis. Many patients with cervical dystonia may experience lack of improvement or sometimes even in some cases worsening of their dystonia if they are being treated as if they had muscle spasm or degenerative disc disease.

However, physical therapists with specialty in neurological disorders neuro-PTs are well versed in cervical dystonia and can definitely benefit, especially when combined with botulinum toxin injections. Neuro-PT has more focus on re-educating the neurological system, using modalities such as sensory reintegration, mirror therapy, and even in some causes virtual reality to correct the abnormal set-point caused by the brain. There is evidence that PT can help the effects of botulinum toxin last longer.

What cervical dystonia treatment do you recommend? Usually just botulinum toxin injection is enough to manage the symptoms of cervical dystonia, including pain, tightness, tremor, and abnormal position of the head and shoulders, sometimes in conjunction with a skilled neuro-PT as above.

Botulinum toxin injection works by reducing the communication between nerves and targeted muscles. Dystonia is a movement disorder characterised by involuntary, repetitive and sustained movements and postures. Dystonia encompasses a broad and complex spectrum of symptoms caused by opposite muscles contracting muscle co-contraction. Cervical dystonia CD is the most common dystonia limited to one part of the body focal or localised dystonia.

CD describes dystonia that specifically occurs in the neck muscles. The condition is characterised by abnormal head posture, involuntary muscle contractions of the cervical spine, head tremor, sustained neck spasms and craniocervical pain.

People with dystonia may show a wide and diverse array of features that can include the following in varying degrees:. Almost all people with CD consider it to be a disability, predominantly due to the pain experienced as a result of muscle overactivity. Individuals with CD report that it has a significant negative impact on their quality of life. In society, there is a lot of prejudice and stigmatisation associated with the condition, and as a result a large proportion of people with CD are depressed and socially withdrawn.

Approximately nine out of , people will develop CD, making it the most common focal dystonia. Alternative diagnoses for CD may mean that this estimate is lower than the actual rate. The condition is more common in women; the female to male sex ratio is approximately 1. CD most often begins during adulthood, with an average onset age of It is very rare for children to develop cervical dystonia.

If a child experiences twisting of the neck it is likely to be a similar but separate condition known as congenital torticollis.

Congenital torticollis is present in some babies at birth. A muscle in the neck is shortened which causes their head to be tilted to the side. This condition can commonly be improved with physical therapy. However, this does not mean that these people contracted the condition as a result of the trauma.

It is still largely unknown whether traumatic events cause the dystonia or act as a trigger for a dormant pre-existing condition. CD that occurs after brain or neck injury is clinically different from other forms of the condition.

In particular, post-injury CD does not improve after sleep, and the head and neck tend to have a more limited range of motion. CD can be classified as focal or generalised. Focal CD is the most common and affects a small muscle group in the neck whereas generalised CD typically starts at an earlier age and is widespread throughout the cervical spine. CD can also be classified either as a primary or a secondary symptom.

CD is said to be primary when it is not a symptom associated with any other neurological brain condition but is a disorder on its own.

The cause of primary CD is still largely unknown. Commonly people with CD will have a family history of movement disorders which suggests a genetic factor however no specific information on genes has been identified yet.

CD is said to be secondary when it is caused by other neurological conditions. There can be many different causes of secondary CD symptoms but whether they are truly causes of CD or simply triggers that activate the disorder remains to be determined. CD can evolve after the following physiological events or diseases:. The first step a doctor will take to diagnose CD is to obtain a detailed medical history, including any past trauma or injury and any balance issues.

This will help to identify tardive dystonia caused by medications or toxins, which is the most common cause of CD. The doctor will ask you to describe your symptoms. If the CD is primary, there are few options for further investigation, as laboratory tests and neuroimaging will not provide much more information.

During clinical examination, the overactive muscles involved in the postural abnormality will be identified by evaluating the range of motion and movement patterns of the head, neck and shoulders. Like all neurological illnesses, the expression and presentation of CD between different people is highly varied. Once symptoms of CD begin, they will usually worsen for an average of 5 years before plateauing.

In some people, the dystonia may spread beyond the craniocervical region. The pain is described as diffuse and exhausting, and branches out from the direction that the head is twisted.

The degree of pain is related to the degree of muscle contraction and the spasms experienced. It has been shown that stress can worsen the symptoms of CD. Therefore, people who feel self-conscious and stressed about their condition are likely to experience a more severe form of the illness. Physical activity and physical exertion are also shown to worsen symptoms. A large proportion of people with CD report depression due to their disability and the disturbed body images associated with the condition.

Show references Dystonias fact sheet. National Institute of Neurological Disorders and Stroke. Accessed July 23, Frontera WR, et al. Cervical dystonia. Philadelphia, Pa. Comella C. Classification and evaluation of dystonia. Cervical dystonia spasmodic torticollis.

Rochester, Minn. Treatment of dystonia. Botulinum toxins. Accessed July 25, Mayo Clinic Press Check out these best-sellers and special offers on books and newsletters from Mayo Clinic.