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Parkinson's Disease

More about spasmotic torticollis

02/15/2007

Question:

Very recently my mum & I went to meet a doctor. According to him my mum is suffering from spasmotic torticollis.All the time she is stressed we noticed that her head starts to tremble. We need to tell her that the head is trembling else she says she doesn`t feel her head trembling. The doctor opted to give a brain injection. I would like to know if with the injection the systoms of her head trembling would be solved or not. Could you please give more information about the spasmotic torticollis and advise whether there is any side effects. Since 15 yrs she is suffering these symtoms and she is 54yrs of age. More information regarding the matter will be of high importance to us as we don`t know much about this illness. thanking you

Answer:

Spasmodic torticollis is also called cervical dystonia. This is a syndrome where there are abnormal spasms and contraction of certain neck muscles. The exact cause is not well understood, but it is known that there is an excess of activity in the nerves that controls the involved muscles.

These abnormal signals result in an imbalance contraction in the muscle involved with keeping the head upright. This commonly results with the head tilting or twisting into an abnormal position. Often, the abnormal signals can also cause the muscles to contract so there would be abnormal movements of the head such as tremor. These abnormal movements and positioning worsen with increased stress and fatigue.

For some people, the symptoms are mild and not bothersome, and for others they can be very debilitating. There is no "cure," but there are available treatments that can help alleviate symptoms.

Treatment is typically started when a person is bothered by the symptoms. There are a several medications a person can take by mouth that can sometimes be helpful. I am not aware of any treatment involving injections into the brain.

The most effective treatment currently available is injecting botulinum toxin into the involved muscles. This toxin blocks abnormal signal from the nerves and allows the muscle to relax. This provides temporary relief of symptoms and often requires regular visits to your doctor for repeated injections about every 3-4 months.

Since this toxin blocks the nerve, there can be too much weakness if the dose is too high, thus causing a temporary difficulty holding up the head. Also, given that this is an injection, there is always risk of infection, bruising, or bleeding caused by the needle as well. Occasionally, there may also be a temporary irritation to the skin around the injection site.

Currently, there are two commercially available botulinum toxins (Botox and Myobloc) and both are effective.

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Response by:

Punit  Agrawal, DO Punit Agrawal, DO
Assistant Professor of Neurology
College of Medicine
The Ohio State University