What Is Cervical Dystonia?

Cervical dystonia (also called spasmodic torticollis) is a neurological condition affecting approximately 60,000 people in the United States. The condition causes muscles in the head and neck to contract involuntarily, making the head move forward and backward, or turn to the side.

Symptoms usually start out mild and worsen with time. Treatments include medication and surgery. In some cases, cervical dystonia can temporarily resolve on its own.

This article discusses the symptoms, causes, diagnosis, and treatment of cervical dystonia.

Symptoms of Cervical Dystonia

Symptoms of cervical dystonia typically are mild at condition onset and may only appear after extended periods of physical exertion, high levels of stress, or when a person is fatigued. Over time, symptoms can start to occur with daily activities and eventually occur at rest. In severe cases, the neck and head can become "stuck" in an involuntary posture.

Within a few months or years, symptoms tend to plateau.

Neck and head movements caused by cervical dystonia can vary from person to person. However, the most common involuntary movement caused by this condition is torticollis—rotating the head to one side while bringing the chin down toward the shoulder.

Other involuntary movements can include:

• Anterocollis (the head tips forward)
• Retrocollis (the head tilts backward)
• Laterocollis (the head tilts to one side)
• Anterior sagittal shift (the head shifts forward)
• Posterior sagittal shift (the head shifts backward)

Individuals with cervical dystonia can also have the following:

• Hand spasms or postural tremors
• Pain in the neck and/or shoulders
• Headaches

Approximately 1 in 3 people with cervical dystonia will have symptoms that spread to other areas of the body, such as the arms, face, or jaw.

What Causes Cervical Dystonia?

The exact cause of cervical dystonia is unknown. However, certain risk factors can increase your chances of developing this condition. Cervical dystonia is more common among 40- to 60-year-old people assigned female at birth and people with a family history of the condition.

Cervical dystonia can also be a secondary condition caused by other medical problems, such as:

• Stroke
• Parkinson's disease
• Traumatic brain injury
• Previous neck injury
• Conditions that affect the basal ganglia (located at the base of the brain)

How Is Cervical Dystonia Diagnosed?

There's no specific test for healthcare providers to diagnose cervical dystonia. Diagnosis is based on a review of your symptoms and a physical exam performed by a healthcare provider familiar with the condition.

How Do You Treat Cervical Dystonia?

There's no cure for cervical dystonia, but medications can help manage the symptoms. Less commonly, this condition is treated with surgery.

Medications

The most effective treatment for cervical dystonia—and other focal dystonias—is Botox (onabotulinumtoxinA). Small amounts of Botox are injected into the affected muscles in the neck to reduce spasms. Results can usually be seen within a few days and last several months.

No drugs are approved by the Food and Drug Administration (FDA) for treating cervical dystonia. However, a healthcare provider may prescribe one of several medications off-label (not for a condition intended for the drug to treat) to help manage dystonia symptoms.

These include:

• Cogentin (benztropine)
• Artane (trihexyphenidyl)
• Klonopin (clonazepam)

Muscle relaxants are also prescribed to help manage symptoms of dystonia. Examples include:

• Zanaflex (tizanidine)
• Flexeril (cyclobenzaprine)
• Robaxin (methocarbamol)
• Norflex (orphenadrine)
• Skelaxin (metaxalone)
• Paraflex (chlorzoxazone)

Deep Brain Stimulation

Deep brain stimulation (DBS) is a surgical procedure that can treat cervical dystonia. It involves placing electrodes into brain structures on both sides of the brain.

These electrodes are connected to stimulators and give off electrical impulses to block the signals that cause cervical dystonia symptoms.

Deep brain stimulation is typically used for people who cannot tolerate the side effects of medications or are no longer seeing improvements in symptoms with the use of medications.

Cervical dystonia is sometimes treated with surgery to destroy small parts of the brain that send signals causing muscles to contract involuntarily. Nerves can also be cut where they attach to the spinal cord or connect with the muscles functioning abnormally to reduce spasms.

Coping With Cervical Dystonia

Muscle contractions and pain caused by cervical dystonia can significantly impact your ability to perform daily tasks and, in severe cases, can lead to permanent disability.

There are additional resources available to improve your quality of life with cervical dystonia, such as:

• Support groups
• Physical therapy
• Occupational therapy
• Stress management and relaxation techniques
• Psychotherapy or counseling

Summary

Cervical dystonia is a neurological condition that causes involuntary muscle spasms in the head and neck. It can also cause pain, headaches, and hand tremors. The exact cause of cervical dystonia is unknown, but it is more common in females and those with a family history.

There is no test to diagnose cervical dystonia. While cervical dystonia is not curable, some treatments help decrease symptoms. The primary treatment is medication. In some cases, surgery is required.