Cervical dystonia, spasmodic torticollis, and wry neck all refer to the same disease. This is when the constant contraction of muscles forces the movement of the neck. If the movement of the head is toward the chest, then it is call anterocollis. If the movement of the head is toward the shoulder, it is lateralcollis. If the movement of the head is toward the back, it is retrocollis. Finally, if the movement is a head turn to the left or right, then it is torticollis. Many patients have a combination of the above movements.
Dystonia is felt to be a disease of the basal ganglia of the brain. This is a collection of neurons (the thinking cells of the brain) that are relatively deeply located. Damage to this area of the brain is known to cause a variety of movement disorders. For this reason, evaluation of this disease typically includes MRI of the brain to rule out a tumor in this area or look for a stroke in this area.The preferred treatment of this disease is usually botulinum toxin injections. Either Botox® or Myobloc® can be used.
The muscles injected and the doses injected into each muscle are individualized for each patient. It is essential that the physician treating the patient identify which muscles are most affected by observing the head position and palpating the muscles. Most physicians utilize the guidance of EMG to locate deeper muscles and verify dystonic firing of these muscles. Within 2 treatments, studies show that 5 of every 6 patients will be much improved. Patients who do not improve with two injections may want to consider trying another injector.
Unfortunately, the treatment wears off every three months or so and has to be repeated. Side effects of both Botox® and Myobloc® include excessive weakening of the targeted and adjoining muscles. For this reason, the side effects have to be explained to the patient based on the muscles that will be injected. Problems with swallowing and holding up one's head are most common. Myobloc® also has the tendency to cause dry mouth.Dosing closer than 30 days is not recommended as it can potentially lead to antibodies that prevent the particular botulinum product from working. If one originally has a good response to the injections and then the response drops or stops completely, then antibodies may be present. The simplest way to check for functional antibodies is injection of the forehead to see if wrinkling becomes impaired. If antibodies develop to Botox®, then Myobloc® can be used or vice-versa.
For those patients who prefer to not have the expense of the botulinum toxin injections, medications such as artane, baclofen, and klonopin can be tried. Unfortunately, their success rate is less than 50%.