A rare but painful condition characterized by involuntary contractions of the neck muscles and which may often result in abnormal positions or movements of head and neck. Cervical dystonia or Spasmodic torticollis can happen at any age (most common among middle-aged people) and sometimes it affects the shoulders. It may be primary or secondary (related with other diseases) dystonia.
Due to involuntary contractions the neck and head may twist in various directions like downward touching the chest, upward, sideways towards the shoulder or ear touching the shoulder. Sometimes it may cause radiating pain to shoulders and headaches. Continuous convulsions are often associated and thus it may be muddled with tremors. Frequent attacks may lead to anxiety and depression.
Causes of Cervical dystonia
The definite cause of primary cervical dystonia is unclear. Secondary dystonia is often related to structural or metabolic causes like injuries, adverse reactions to drugs (especially neuroleptic medications) or disturbances in signal transmission from brain to muscles.
Although no particular age group is a risk factor for cervical dystonia, it is common after 30years. Females are at more risk than males. Family history is another pre-disposing factor. Stress often increases the incidence. Secondary dystonia is sometimes associated with cerebral palsy among children.
Treatment of Cervical dystonia
There is no particular treatment for Cervical dystonia and usually the condition resolves by itself. Otherwise, management of signs and symptoms are enough. Botulin toxin injection (eg: Botox, Dysport, Xeomin and Myobloc) to the neck is the available treatment of choice, but repeated doses are needed every 3-4 months. Additionally, oral administration of muscle relaxing drugs is recommended. Simple sensory tricks (differs for individuals), like stimulating the opposite side of face or the occiput, often work in achieving a temporary relief. Application of hot packs and massaging techniques are also useful. Persons with the history of Cervical dystonia should spend some time for neck exercises regularly in order to improve the strength and flexibility of the muscles. Rarely surgical interventions like deep brain stimulation, or selective denervation are needed to correct the abnormality.
Complications of Cervical dystonia
Dystonia may spread to jaw, face, arms or even trunk. Recurrent episodes often lead to development of bony projections on cervical vertebrae into the spinal column resulting in impingement of spinal cord. As a result, the person may experience numbness & weakness of arms, hands, legs and feet.
Preventive measures of Cervical dystonia
Ayurvedic Concept of Cervical dystonia
The term Akshepaka denotes the involuntary movements & tremor-like actions of a body part. Cervical dystonia is understood as conditions explained as Akshepaka, Manyastambha and Bahirayama in Ayurveda. All these diseases are due to Vaata vitiation. It develops mostly as a result of the blockage of the normal route of Vaata by other doshas, in neck. Rarely in oldage or degenerative diseases the condition can result out of Vaata kopa due to dhatukshaya.
Ayurvedic Nidana of Cervical dystonia
Causative factors for the vitiation of Vaata
It can happen in two ways.
Aavarana – When the kapha gets vitiated or aama present, the channels in the body get obstructed. It is called as srotorodha. It causes obstruction to the normal path of the movement of Vaata and makes it move in abnormal paths. In other words, it affects all types of circulation and communication within the human body.
Dhaatukshaya – In degenerative conditions like old age, poor nourishment, chronic diseases, fasting, stress etc., body tissues undergo excess depletion and the vitiated Vaata gets into the void spaces and causes the disease.
Ayurvedic treatment for Cervical dystonia
In cases with Aavarana, the first line of management is Rookshana with herbal powder massage or pouring medicated herbal decoctions over the area to reduce the pain & stiffness, if present. Swedana(sweat-inducing therapies), Teekshna nasya(nasal drops that clear the sinuses and empty spaces inside the head from accumulated waste products) and dhooma prayoga(fumigation with herbs) will help the vitiated doshas melt and remove the obstruction. After that, oil massage of the head neck and body can be done, with therapies for head like Siropichu or Murdha taila.
Medicated herbal oils and ghee preparations are used for massage and Nasal drops in cases of degenerative Vaata kopa followed by Sirovasti, Siropichu or Murdha taila.
Herbal Preparations for Cervical dystonia
Diet & Regimen
Healthy balanced diet according to the digestive power is recommended.
Avoid excess oil, fat, salt, spicy and junk food items.
Eat only when you are hungry and avoid overeating.
Avoid sedentary lifestyle, do regular exercise.
Use a convenient pillow and avoid injury to the neck while sleeping.
Yoga & Pranayama
Yoga postures & Pranayamahelpful in cervical dystonia are:
Sukshmavyayam of all sandhis especially neck
Bhastrika – especially in cases with stiff neck due to Srotorodha
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