Cervical dystonia is characterized by involuntary tonic contractions or intermittent spasms of the neck muscles. The cause is unknown usually. The diagnosis is made clinically. Treatment may include physical measures, drugs and selective denervation of neck muscles with surgical procedures or locally injected botulinum toxin.
In cervical dystonia, the contraction of the neck muscles to the neck of his usual position deviates leads. It is the most common dystonia.
Cervical dystonia is characterized by involuntary tonic contractions or intermittent spasms of the neck muscles. The cause is unknown usually. The diagnosis is made clinically. Treatment may include physical measures, drugs and selective denervation of neck muscles with surgical procedures or locally injected botulinum toxin. In cervical dystonia, the contraction of the neck muscles to the neck of his usual position deviates leads. It is the most common dystonia. Spasmodic (beginning in Erwachsenensater) torticollis is the most common form of cervical dystonia. He is idiopathic in general. Some patients have an appropriate family history, and some of them have a genetic cause has been identified (eg. As DYT6, DYT7). Some of these patients have more dystonia on (z. B. of eyelids, face, jaw, hand). Cervical dystonia may be a consequence of other diseases such as Congenital lesions of the brain stem or the basal ganglia or the use of dopamine-blocking drugs (eg. As haloperidol) occur rarely has a dystonia psychogenic causes. In this type of dystonia pathophysiology is not well understood, it, however, changes in brain function have been demonstrated by functional imaging. In many cases, an emotional stressor or abnormal beliefs are identified as a trigger. In these cases, a multidisciplinary team including a neurologist, psychiatrist and psychologist, is necessary. Symptoms and signs The symptoms of cervical dystonia can begin at any age, but most often they first appear between 20 and 60 years on, with a peak at the age of 30-50 years. The symptoms develop usually gradual, rarely suddenly put on and are progressing rapidly. Sometimes the symptoms start with a tremor that turns the neck (in a no-no-touch). The symptom is painful, tonic contractions or intermittent spasms of the sternocleidomastoid, trapezius and other muscles of the neck, which usually occur unilaterally and cause abnormal head position. Unilateral contraction of the sternocleidomastoid causes rotation of the head to the opposite side. The rotation can affect any level, but almost always has a horizontal component. In addition to a rotating tilting (torticollis), the head or the side (Laterokollis), forward (Anterokollis) or reverse (Retrokollis, often occurs when dopamine blocking drugs are the cause) tilt. Patients can find out sensory or tactile tricks that reduce the dystonic posture or tremor (z. B. touching the face on the contralateral side to deviation). In sleep, the muscle spasms disappear. The torticollis spasmodic can be mild to severe expresses. He usually progresses slowly over 1-5 years ahead and then remains at a level. Approximately 10-20% of patients have within 5 years after the start of a spontaneous regression on (usually in less severe cases and in younger age). However, the torticollis may remain for life to exist and lead to reduced mobility and deformed posture. Diagnosis Clinical Investigation The diagnosis of cervical dystonia is provided due to the characteristic symptoms and by excluding alternative diagnoses, as shown below: A Spätdykinesie may cause torticollis; However, the distinction can usually be made on the basis of chronic use of antipsychotics in the history or by involuntary muscle movements outside of the neck. Disorders of the basal ganglia and occasionally CNS infections can cause movement disorders, but they usually affect other muscles; CNS infections are usually acute and cause other symptoms. Infections or tumors of the neck are usually distinguished by the symptoms of the primary process. Antipsychotics and other medications can trigger an acute torticollis, haven `the symptoms develop within hours and disappear within days after discontinuation of medication. Therapy Physical measures Sometimes botulinum toxin or oral medications spasms can sometimes temporarily by physical therapy and massage, incl. Sensory biofeedback methods (eg. As lighter tactile pressure on the jaw on the same side as the head rotation), and inhibit any slight touch. Drug injections of botulinum toxin type A or B in the dystonic muscles may reduce for 1-4 months the painful spasm at approximately 70% of patients, wherein a neutral position of the head is achieved. In some cases, however, the effectiveness of the toxin decreases when it is repeatedly injected as neutralizing antibodies against the toxin are formed. Oral medications can relieve pain usually, but the dystonic movements suppressing only about 25-33% of patients. These drugs include anticholinergics such Trihexiphenidyl (10-25 mg PO once or 2 times / day) (but often limit unwanted effects their use) benzodiazepines (especially clonazepam 0.5 mg po bid) Baclofen Carbamazepine All drugs should be low doses are started (e.g., B. Trihexiphenidyl 2 mg po 3 times / day). The dose should then be increased until symptoms are under control or nichttolerable side effects (particularly common in the elderly) may occur. Surgical procedures Surgical procedures are controversial. The most promising surgical approach is a selective denervation of the neck muscles involved with the ongoing weakness or paralysis as a result. The results are favorable, if the intervention of centers is carried out, which thus possess great experience. Important points torticollis spamodicus is a common cervical dystonia with onset in adulthood and usually idiopathic. The diagnosis is made clinically and involves the suspension of tardive dyskinesia, Basalganglienstörungen, CNS infections, throat infections and tumors and drugs. Treatment usually consists of physical measures, botulinum toxin injection and / or oral medications.