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Spasmodic Torticollis

Spasmodic torticollis (ST) is also called cervical dystonia. Dystonia is a neurological movement disorder characterised by involuntary muscle spasms and sustained muscle contractions. Dystonia can affect just one muscle or a group of muscles or all of your muscles. In the case of ST, the muscles in the neck go into involuntary contractions. These sustained muscle contractions result in twisting, turning or tilting of the head and neck, and sometimes jerky head movements. Pain can also accompany the involuntary muscle contractions in the neck.

Although it is said that ST occurs as a result of a dysfunction of the brain, the exact cause to how the nervous system of the brain goes awry remains unknown. ST can resemble other disorders such as Parkinson’s disease, epilepsy, muscular dystrophy and wry neck. In order to exclude these conditions, various diagnostic tools are utilised by the physician. The electromyography (EMG) is used to help assess and diagnose muscle and nerve disorders. It can help to confirm whether the patient is having ST or another condition. A Magnetic resonance imaging (MRI) may be used to rule out ST and identify the presence of tumour or stroke whereas a blood test will reveal the presence of toxins.

ST usually occurs between the ages of 25 to 55 years old, with a higher incidence in women than in men. There also seems to be a genetic link, with 3 percent of patients reporting at least one relative with ST, and 50 percent of patients with a family history of tremors in the hand or head.

The symptoms associated with ST always occur slowly or intermittently, reaching a plateau in 2 to 5 years. The pain that is normally associated with ST is always focused on one place. Frequently, the pain is noted at the side of the neck or at the back of the shoulders.

To date, there is no cure for ST. However, there are a number of treatments that have been shown to provide some relieve. These include botulinum toxin injection, stress reduction techniques and physiotherapy. If all these intervention fail, patients will have two choices of surgical procedures, either deep brain stimulation or denervation surgery. A deep brain surgery is where a thin insulated wire is inserted into the brain via a small hole cut into the skull. This wire will then send electrical pulses to the brain to block the nerve signals that caused your head to twist. On the other hand, a denervation surgery involves cutting the nerves or the muscles that are responsible for the contorted posture associated with ST.

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