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Medical Edge Newspaper Column from Mayo Clinic
OPTIONS FOR INTRUSIVE NECK SPASMS
DEAR MAYO CLINIC: I have had cervical dystonia for nearly five years. It occurs primarily when I lie down. I was given several injections of Botox, though it worked only the first time, and several other drugs were also ineffective. Do you have any suggestions for treatment? — Santa Rosa, Calif.
ANSWER: Cervical dystonia, also called torticollis, is a condition in which neck muscles involuntarily contract and cause the head to turn, twist or tilt to one side, sometimes repetitively, typically resulting in abnormal and often painful postures.
Though the problem can be caused by underlying diseases, for most patients CD has no known cause. While the precise area of the brain involved in CD is unknown, it is thought to come from a malfunction of the basal ganglia, a part of the brain involved in movement. Brain scans, however, are normal.
Oral medications may be used to reverse the muscle spasms and uncomfortable neck postures, but they tend to be only mildly helpful at best. Muscle relaxants theoretically should be effective, but they, too, either fail altogether or result in only modest improvement.
The most effective treatment is injection of botulinum toxin (Botox) directly into the affected muscles. Botulinum toxin weakens the muscles for two to three months, reducing the spasms. To sustain this effect, the injections must be repeated. The procedure has few side effects.
Botulinum-toxin injections are very helpful for most people with CD, but they sometimes fail. In some cases, the patient develops antibodies to the botulinum protein, which block the drug’s effectiveness. In such cases, a different strain can be tried: Two strains (botulinum toxin-A and botulinum toxin-B) have been approved by the U.S. Food and Drug Administration (FDA). Perhaps the resistance you soon showed to the first type of Botox could be overcome with the alternative form.
In some people, the muscle contractions of CD only occur in certain positions or with certain activities. In your case, the CD apparently is linked to lying down, which must impair your ability to sleep. Discuss with your doctor whether a sleep aid or pain reliever would be helpful to override the discomfort and allow you to get some rest.
For people with very troublesome CD that fails to respond to botulinum toxin and other medications, surgery may be appropriate. A procedure called selective denervation involves cutting the nerves to the neck muscles that are in spasm. The rationale is similar to that of botulinum-toxin injections: trading spasm for muscle weakness. Only a few neurosurgeons in the United States perform this surgery. But in the right hands, it can be very effective.
A different surgery, deep-brain stimulation, involves a pacemaker-like device that is implanted in basal-ganglia brain regions. This option has recently been tried in a few people with CD, but because it still requires further study, we cannot currently recommend it for treatment of CD.
— J. Eric Ahlskog, M.D., Neurology, Mayo Clinic, Rochester, Minn.
Additional Resources:
Neck Spasms (Cervical Dystonia or Torticollis)
Appointment Information
More Information on Cervical Dystonia
READERS: If you experience chest pain that persists for more than 15 minutes or have any other reason to believe you may be having a heart attack, don’t delay. Call for emergency help.
Every year, about 1 million Americans experience a heart attack. Unfortunately, on average, people usually wait about three hours after their signs and symptoms first appear before seeking medical care.
Time is critical when a heart attack is underway because heart muscle is dying. A heart attack results from an interference with blood supply leading to injury of the heart muscle. Usually the problem is due to blocked circulation in one or more of the heart’s coronary arteries.
Immediate emergency medical care can mean the difference between life and death. The steps taken by paramedics and by the staff at the emergency department are designed to detect, interrupt and treat a heart attack. And the quicker, the better.
Additional Resources:
Heart Attack Symptoms
Appointment Information
More Information on Heart Attacks
Heart Center
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