What is Cervical Dystonia?
What is Cervical Dystonia? Cervical Dystonia is a medical condition characterized by a disturbance in the movement of muscles, so that the muscles will contract repeatedly without conscious.
This repetitive motion causes of Cervical dystonic sufferers to often have unusual posture and sometimes experience tremor. Cervical Dystonia can attack only one limb (focal dystonia), two or more related body parts (segmental dystonia), or whole body (general dystonia).
Based on the cause, Cervical Dystonia a is divided into two categories, namely primary Cervical Dystonia and secondary Cervical Dystonia. Primary Cervical Dystonia is Cervical Dystonia whose cause is not known clearly, but some of its cases are known to be caused by genetic or hereditary mutations, and usually occur in young age.
Secondary Cervical Dystonia can occur due to various trigger conditions such as
- Disturbances in the nervous system – for example, in people with Parkinson’s disease and multiple sclerosis.
- Disorders of the brain – for example, are cerebral palsy that often occurs before or shortly after birth, brain tumors, and stroke.
- Infections that can cause dystonia include HIV and inflammation of the brain or
- Drugs – medicines in question is a type of anti psychose (medication to overcome mental disorders) Or anti seizure drugs (used to treat epilepsy).
- Wilson’s disease – a condition in which there is a buildup of copper in body tissues.
- Huntington’s disease – a hereditary disease that can result in mental disorders.
- Trauma – usually an injury that attacks the skull or spine bone.
Cervical Dystonia itself is not a common medical condition. Noted, dystonia affects 1% of the world’s population, with more women than men. Unfortunately, there is still no data on the incidence of dystonia in Asia, especially in Indonesia.
Symptoms of Cervical Dystonia
Symptoms of Cervical Dystonia vary widely, depending on the type of Cervical Dystonia and the onset of the onset. By time, Cervical Dystonia is divided into two, ie early onset Cervical Dystonia and slow onset Cervical Dystonia.
In early-onset dystonia, early symptoms will appear at the age of children or adolescents. Symptoms usually start from the arms or legs before they spread to other parts of the body. Here are some types of early onset Cervical Dystonia as well as its symptoms.
- Cervical Dystonia generalization: Cervical Dystonia generalization often attacks children before adolescence, and the symptoms usually begin from the leg muscle before spreading to other limbs. Some of the symptoms that can arise include muscle cramps, crooked and abnormal postures, legs and arms bend inward, and seizures.
- Cervical Dystonia dopa-responsive: Cervical Dystonia dopa-responsive belongs to the generalization dystonia group, and usually affects age groups 6-16 years. The most common symptom is a rigid and strange walk. The soles of the feet can bend upwards, or can bend to the outside. Other symptoms such as muscle stiffness and cramps in the arm and shoulder can occur, though rarely.
- Cervical Dystoniamyoclonus: This is a rare type of dystonia, where body parts such as arms, neck, and shoulders can be stricken. Usually, this dystonia attacks two related parts of the body (segmental dystonia), and causes symptoms such as sudden jerks like electric shocks.
- Cervical Dystonia paroxysmal: This type of dystonia is most rare, and the symptom is usually a sudden seizure that can occur under certain conditions such as stress or fatigue. These symptoms are often equated with epilepsy, but in this condition the patient is still conscious and can experience seizures for several minutes to hours.
As for slow onset dystonia, early symptoms begin to appear in adulthood, and attacks usually begin from the head, neck or arms and do not spread to other body parts. The late onset symptoms do not spread to the rest of the body. Which include slow onset dystonia is:
- Cervical Dystonia: Cervical dystonia or also called torticollis is a dystonia that attacks only one part of the body (focal dystonia), ie the neck.
Contraction in the neck can cause the neck to spin up (up), down (down), or sideways.
- Blepharospasm: Blepharospasm is a condition in which muscle weakness occurs around the eyes, so the eyes will be unconsciously closed. In some severe cases, the patient is unable to open his eyes.
- Writer’s cramp: Writer crash or so-called task-specific dystonia is dystonia which results in unconscious tremor (tremor) movement in the muscles of the arms and wrists. These symptoms often attack writers, musicians, golfers to someone who often typing with excessive frequency.
- Dystonia larynx: In the laryngeal dystonia, the muscles around the vocal cords (larynx) will become stiff, resulting in a sound like “choking” or “wheezing”. The resulting sound also depends on the laryngeal muscles becoming rigidly outward or inward.
- Oromandibular Dystonia: Oromandibular dystonia is a type of dystonia that attacks the lower facial muscle area, tongue, or jaw. Movements that can be caused include winces, lips pursed, jaw open and closed repeatedly, and there is movement spontaneous tongue that can not be controlled. Patients will usually also have difficulty swallowing food.
- Hemophasial seizures: Symptoms that occur include repeated twitching on one side of the face, usually on the eyes or mouth.
Diagnosis of Cervical Dystonia
To make a diagnosis of Cervical Dystonia, doctors usually require several stages to determine the main cause of the dystonia. The doctor may ask you some things like:
- The age at which the symptoms appear for the first time
- Sequences of affected body parts
- Is the disease deteriorating rapidly
From these questions, your doctor will be able to tell if you have primary or secondary Cervical Dystonia. If you are suspected of secondary Cervical Dystonia, you may be advised to undergo the following additional checks to find out the main cause of dystocia.
- Urine test and blood sample – this test aims to examine the function of organs, such as the liver, as well as to see whether there is an infection process or toxic compound levels in your body.
- Genetic testing – DNA sampling is usually used to find out if you have gene disorders associated with dystonia. DNA tests can also determine if your dystonia is caused by a genetic disease like Huntington’s disease.
- Magnetic resonance imaging (MRI) – this imaging test is useful for checking for any disturbance or damage in the brain, and can be useful also for detecting tumors in the brain.
- Electromyography (EMG) – This test serves to measure the electrical activity in the muscle.
Treatment of Cervical Dystonia
Cervical Dystonia can not be cured, but there are some treatments that can be done to reduce the frequency of the appearance of symptoms and the severity, namely through:
- Botox Injections (Botulinum Toxin): Botulinum toxin works by inhibiting compounds that cause stiffness / muscle spasms so as not to reach target muscle targets. Botulinum toxin is administered by injection, and is performed directly in the affected area. The effects of Botox injections will last for two to three months before a repeat injection is performed. Botox injections are usually given in focal dystonia or dystonia
- Drugs: Drugs given are a type of drug that works to block signals in the brain that stimulate muscle stiffness. The doctor may prescribe several medications according to the condition of the patient, such as levodopa (to control motor movement and may also be given to people with Parkinson’s disease), anti cholinergic drugs (to inhibit the chemistry of acetylcholine causing muscle spasms), balcofen (to control seizures and may also be given In patients with cerebral palsy or multiple sclerosis), diazepam (for a relaxing effect), tetrabenazine (for inhibition of dopamine), and clonazepam (to reduce excessive muscle movement symptoms).
- Physiotherapy: The doctor may also suggest therapy such as physiotherapy, massage or muscle stretching to relieve muscle pain, speech therapy, sensory therapy to reduce muscle contraction, to breathing exercises and yoga.
- Surgery: There are two types of surgery doctors may recommend if there are no successful treatments, including deep brain stimulation and selective denervation operations. In brain stimulation operations, the doctor will infuse electrodes or batteries in the brain and combine them with electricity in the body to inhibit the symptoms of dystonia. While in selective denervation operations, the doctor will cut off the nerve causing muscle spasms to permanently stop the symptoms.
Before doing therapy or taking any medication, make sure you are aware of the possibility of side effects, such as drowsiness, nausea, confusion, difficulty swallowing, double vision, voice changes, dry mouth, constipation, difficulty urinating, difficulty remembering, Lose balance. Consult a physician to find out which side effects might occur according to your condition.
Cervical Dystonia Complications
There are several complications that may be experienced by people with Cervical Dystonia, depending on the type and location. These complications include:
- Limitations of motion, making it difficult to perform daily work
- Difficulty moving the jaw, swallowing, or talking
- Fatigue and pain due to excessive muscle contraction
- Blindness (if dystonia attacks the eyelid)
- Psychological problems (anxiety, depression, or even withdrawal from society)
In addition, there are also several possible complications that may occur after surgery, such as the cessation of electrodes or battery installation errors in brain stimulation operations, or swelling, punctured pain, and neck infection after selective denervation surgery.