Spasmodic torticollis: causes, symptoms, and treatment

Spastic torticollis (cervical dystonia) is a neurological disease, the main symptom of which is the wrong forced position of the head (most often with a slant sideways and turning). Modern medicine believes that the disease is based on violations in the extrapyramidal system of the brain. The disease does not in any way affect life expectancy, but it violates social adaptation, leads to loss of ability to work and difficulty of self-service. The most effective treatment for spastic tortoises is the use of botulinum toxin and stereotactic surgery. This article will give you an opportunity to learn more about the causes, symptoms and ways of treating spastic tortoises.

The term "spastic torticollis" must be correctly interpreted. Krivosheya can arise as a result of many reasons, anomalies in the structure of the muscles of the neck (in this case it is congenital and immediately noticeable). Spastic same torticollis - this is a pathological condition in which the wrong position of the head is associated with a violation functions of normal neck muscles when they receive excessive stimuli from the brain, which leads to an increase in their tone. It turns out that spasmodic torticollis is an acquired disease.

To the normal physiological position of the head is the position when the look is directed straight ahead, the head is not turned in any direction, is clearly on the median line. This position is achieved by a certain tension of the neck muscles, which is not felt by the person and is regulated by the brain without strong-willed control. That is, no one thinks about what muscles need to be cut and which ones to relax so that the head takes this position. With spastic crooked balanced muscle contraction is disrupted for some reason, there is a predominance of muscles one half (right or left) over the other, which leads to the fixation of the head in a different, non-physiological position. This position is not controlled by man, that is, the head itself occupies such a position. Initially, a person's attempts to return his head to a normal position are successful, but require volitional efforts. And as the disease progresses, even strong-willed control is not able to give the head the right attitude.

Causes

For what reason do the "wrong" impulses come to the muscles of the neck, causing them to excessively contract, thereby causing the atypical position of the head?

It is believed that the basis of spasmodic torticollis is the dysfunction of the extrapyramidal system. This is part of the brain, which, first of all, provides automatic stereotyped movements. If the balance of neurotransmitters (substances-transmitters of information between neurons) is disturbed in the extrapyramidal system, synaptic transmission between nerve cells, then this is manifested by a violation of any body movements. In particular, coordination of the contractile activity of the neck muscles may be impaired. There is excessive impulse, which causes the muscles of one half of the neck to be in constant tension and often contract, and this, in turn, turns the head wrong.

Violation of the creation of impulses in the extrapyramidal system with spastic crooked arises when:

• hereditary predisposition;
• transferred cerebral infections (encephalitis);
• suffered head and neck injuries;
• admission of neuroleptics;
• toxic lesions of the brain;
• strong emotional stress.

Also in recent decades, it has been found that there is a so-called peripheral form of spastic tortoise, the occurrence of which is associated with the presence of cervical osteochondrosis of the spine (according to the reflex type).

Symptoms

Spastic torticollis is a relatively common disease: 10 cases per 100 thousand of the population. At the same time, the female sex is not luckier by more than 2 times, because exactly 2 times more often women suffer from spastic torticollis. Up to 80% of cases occur between 19 and 40 years. So spasmodic torticollis is a disease predominantly of people of working age.

Spasmodic torticollis can begin acutely or gradually, the latter variant occurs more often. Sometimes the disease makes its debut with pain in the cervical spine. The main manifestation of the disease is an incorrect position of the head with difficulty of arbitrary movements in the neck. Most often, the main muscles of the neck and partly the back are involved in the process: sternocleidomastoid (nodding), belt and trapezoid. In one or more muscles, the tone rises, which leads to a turn of the head. Depending on how the head is rotated, it is customary to distinguish:

• torticollis - turning the head to the side;
• antecollis - forward or tilt head forward;
• retrokollis - tilt the head back;
• laterocollis - inclination of the head to the side (to the shoulder).

The most common is a mixed form, for example, with a simultaneous rotation and turning the head to the side.

At first, the person makes an effort and can keep his head in the usual position, however this does not last long. Then the patient has to use the so-called corrective gestures: for example, an easy touch to some areas of the face allows you to slightly correct the position of the head (touching the forehead, rubbing the chin, wrapping the neck with a scarf, and so on). Therefore, patients now and then touch the face. Even later, putting the head in the right position requires the participation of hands, but as soon as the hands release the head, it again turns incorrectly. As further progression progresses, independent head turns become impossible.

In addition to the incorrect posture of the head, another symptom of spasmodic torticollis is the pathological movements of the head. They are involuntary, that is, they arise out of the will of the patient. Movements can be almost invisible in the so-called tonic form, as well as very pronounced, the first conspicuous in the clonic form of the disease. Expressed movements look like an incessant nod or a "no-no" turn.

Constant muscle tension leads to their thickening (hypertrophy), pain. Both tension and hypertrophy are easily determined by probing the corresponding muscles.

Although the spasmodic curve is dominated by the tension of one or two muscles, as the disease progresses, more and more muscles are involved in the process. And then the head occupies an incorrect position relative to already several planes.

Occasionally, there is a situation where the tension in the muscles is the same on both sides. In this case, there is no preponderance, and therefore the head remains in the correct position. There is a paradox: spasmodic torticollis without torticollis. In this case, despite the seemingly correct position of the head, use the diseased muscles of the patient can not, head turns are carried out due to unaffected muscles of the thoracic spine. Pain and expressed muscle tension with this form are determined from both sides.

For the flow of spasmodic torticollis, several features are characteristic:

• most manifestations are minimal in the morning;
• all symptoms are aggravated by agitation, stress, walking;
• in the supine position, in sleep and with the support of the head with the support of the hands, the symptoms decrease.

Sometimes spasmodic torticollis is combined with trembling of the hands (tremor).

Prolonged intensive spasms in the neck muscles again lead to problems with the cervical spine. Can prolapse discs, compression radiculopathy (compression of the nerve roots when leaving the spinal canal).

Treatment

Treatment of spasmodic torticollis is a difficult task. The fact is that most drugs have minimal therapeutic effect, or it is too short. And yet for a while he manages to help the patient with only conservative methods. When they are exhausted, then they resort to surgical treatment.

Conservative methods of treatment

These methods consist in the stage-by-stage application of the entire arsenal of non-operative methods of treatment.

At the first stage, drugs are used.

Of the drugs used Baclofen (muscle relaxant), Clonazepam (anticonvulsant with the effect of relaxing the muscles), Carbamazepine (Finlepsin). Sometimes they are combined with anticholinergics (preparations like Cyclodol, Akineton, Norakin and others) and with antidepressants.More effective, to date, recognized the use of botulinum toxin (Disport, Botox). Introduced intramuscularly (in the area of ​​the affected muscle), botulinum toxin blocks the transmission of the neuromuscular pulse for a while. If botulinum toxin was introduced correctly, then its action is sufficient for 4-6 months. After this time, the drug should be repeated. And so they do for years.

The second stage consists in the use of methods of acupuncture and manual therapy. Manual therapy is carried out very carefully, using the relaxation technique, and only with the clinical effect of weakening muscle tension.

The third stage consists in the formation of the correct motor stereotype, that is, the elimination of motor disorders, indirectly formed as a result of spastic tortoise, namely - lifting the shoulder on the side of the turned head. This lifting of the shoulder provokes changes on the side of the spine. For its elimination use special gymnastics and receptions of autorelaxation.

The use of such a step-wise treatment in almost 60% of cases reduces the symptoms of spastic torticollis: the duration and the severity of spasms (tension) of the muscles of the neck, pain disappears, the intervals between attacks of involuntary movements of the head increase.

When conservative treatment has no effect, resort to surgical methods.

Surgical methods of treatment

Previously, surgical treatment consisted of cutting the most affected muscle (usually sternocleidomasto-mastoid) or its tendon, or innervating its nerve. However, these methods had many complications, because they caused muscle paralysis, impaired sensitivity and blood supply, so they are no longer being used.

Modern medicine offers stereotaxic operations on the brain for the treatment of spasmodic torticollis. Through small holes in the skull, electrodes are supplied to the structures of the extrapyramidal system (stereotaxic interference accurate calculation of the location of the instrument and electrodes without damage to the vital structures of the brain). At first, using stereotaxic techniques, they simply destroyed certain parts of the extrapyramidal system, thereby eliminating the symptoms of the disease. However, the implantation of the electrodes proved to be a more gentle and simultaneously effective method. Electrodes are tuned to a high stimulation frequency (130-150 Hz) and inhibit the formation of pulses that stimulate excessive reduction of the muscles of the neck, thereby relieving the patient of the cause of spastic torticollis. To date, has accumulated many years of experience in the use of such operations with great success.

Thus, spasmodic torticollis is one of extrapyramidal diseases of the nervous system. Its symptoms are very unpleasant and difficult to tolerate in connection with cosmetic and social defects, as well as the banal difficulties in self-service. If spasmodic torticollis is not treated, then it will progress, involving new muscles in the process and aggravating the already difficult situation. For its treatment conservative and operative methods of treatment are used. If surgical intervention could not overcome the problem, then neurosurgeons in almost 100% of cases will help the patient.

Educational program on neurology, lecture e. m. Kotova A. FROM. on the topic "Spasmodic torticollis":