Spasmodic Torticollis Treatment in Delhi, India

Spasmodic torticollis or cervical dystonia is a rare and painful state where your muscles in the neck get contracted on their own. This causes the head to turn on one side. The spasmodic torticollis may also result in your head getting tilted uncontrollable either forward or backward.

Spasmodic torticollis is a very rare disorder. This can happen at any age but is mostly seen in middle-aged persons. The women folk are relatively more prone to this condition than men. The symptoms begin slowly and gradually increase to a point of no return. There is no medicine for spasmodic torticollis. At best botulinum toxin may be injected to somewhat control the signs and symptoms of spasmodic torticollis.

Spasmodic torticollis is an extremely painful condition because of the unnatural position of your head. This may have ramifications in your social life and affect your employment as well.

The causes of spasmodic torticollis are unknown, however, some genetic factors cannot be ruled out.

Associated Anatomy of Spasmodic Torticollis

Spasmodic torticollis or cervical dystonia is a neurological disorder which originates from the brain. The affected muscles come from the accessory nerve called Cranial Nerve XI. However, the 2nd, 3rd and 4th cervical nerves are also affected by spasmodic torticollis.

Torticollis is a condition of horizontal turning of the head. While doing so, ipsilateral splenius and contralateral sternocleidomastoid muscles are used. These are located in the chin to shoulder area of the body.

Spasmodic Torticollis Symptoms

Spasmodic torticollis causes the head to twist and turn abnormally. The contraction of the nerve causes the head to twist in different directions.

Some of the signs and symptoms of spasmodic torticollis are as under:

• Torticollis - This is the most common posture noticed in a person affected by spasmodic torticollis. In this condition, the chin is twisted towards either of the shoulders, and the head starts rotating sideways.
• Anterocollis - In this condition, the head tends to tilt forward.
• Retrocollis - This is a condition where the head tilts backwards.
• Laterocollis - A person with this condition will find the head to tilt towards one side.
• Anterior Sagittal Shift - In this condition the headrests on the shoulder and bend forward.
• Posterior Sagittal Shift - This is a situation, where the head bends backwards while resting on the shoulder.

Other symptoms that can be associated with spasmodic torticollis are trembling hands. The symptoms may get worse with stress. It has been noticed that symptoms have improved with some sensory tricks like touching the cheek of the patient.

A very small segment of people may also experience spontaneous remission of spasmodic torticollis. But these are temporary reliefs and eventually, recurrence of the disease is noticed. Less than 1 percent of the affected people are lucky to get permanent remission of spasmodic torticollis.

The person having spasmodic torticollis experiences some secondary problems as well. The common secondary problems are spine arthritis, nerve roots getting compressed, and narrowing of the spinal cord around the neck region. The patient feels severe muscular pain in the region where the head is turned or twisted.

Spasmodic Torticollis Causes

There are no identifiable causes that may lead to spasmodic torticollis in a person.

However, there may be some other underlying cause leading to spasmodic torticollis and hence, may be considered a consequential disorder. Some of such causes as under:

Genetic susceptibility

Approximately 10-25% of the patients having this condition have a similar family history.

Gene mutation

Mutations in genes like GNAL, THAP1, CIZ1, and ANO3 may lead to spasmodic torticollis.

Congenital infantile torticollis

This is an inherent disorder where the baby is born with a short neck muscle which eventually leads to spasmodic torticollis.

Doctors are also of the opinion that spasmodic tortillas may occur in a person as a result of the use of certain drugs such as antipsychotics or anti-nausea medicines.

Spasmodic Torticollis Diagnosis

As a standard practice to carry out diagnosis clinical examinations are carried out by the medical practitioners. Apart from the clinical examinations, doctors obtain detailed case histories and ascertain the signs of spasmodic torticollis and the stage at which the disease has reached.

There are no specific laboratory tests associated with spasmodic torticollis. However, some of the tests are carried out, are:

• Magnetic Resonance Imaging (MRI) of the brain.
• MRI of the neck.
• Electromyography – this is done in case there are palpable signs of nerve irritation.

Spasmodic Torticollis Treatment

The treatment of spasmodic torticollis is mainly symptomatic and is planned around easing the pain and agony of the affected person.

Some of the standard treatments of spasmodic torticollis include:

Botulinum Toxin Injections

It is a very common symptomatic treatment of spasmodic torticollis. The botulinum toxin prevents the affected nerve from releasing acetylcholine, thereby muscle does not contract to cause the head to tilt. The effects of the injection typically start taking place after 2-3 days. The best effects are found after 4 weeks of injection. The patient who has undergone this treatment may expect relief of 2-6 months.

Oral Medication

Among the medications that are given orally to a patient suffering from cervical dystonia or spasmodic torticollis, dopaminergic agents like levodopa are used. Apart from this, anticholinergic medicines like benztropine, baclofen, clonazepam and trihexyphenidyl are frequently used to treat spasmodic torticollis.
The usual side effects of medication are memory loss and sedation. The side effects start occurring even at the initial stage of medication.

Deep Brain Stimulation Surgery

Deep Brain Stimulation Surgery operation entails the placement of electrodes in the brain area and electronic pulses are sent to the brain.

Risk Factors of Spasmodic Torticollis

• Women are twice as likely to be at risk of spasmodic torticollis than men.
• This disease often occurs in office settings.
• Spasmodic torticollis occurs mostly in people between 40 and 60 years of age.
• There is no ethnicity attached with this ailment.