Neck Problem

Torticollis

Also known as cervical dystonia or a “Wry neck” can now respond to various forms of advanced surgical treatment, as seen here…

Treatment

Physiotherapy

  • Passive stretching and proper head positioning is used in infants and small children. In passive stretching, a stap is usually used to hold the head in a certain position. These treatments are often successful, especially if they are started within 3 months of birth.
  • Applying heat, traction to the neck and massage to help relieve head and neck pain.
  • Stretching exercises and neck braces to help with muscle spasms.

Medications

Anticholinergic drugs– are considered to be the most effective for treatment of torticollis.

  • Trihexyphenidyl– It has a central antimuscarinic action. It shows benefits in symptomatic treatment of segmental and generalized dystonia. And is also useful for treatment of generalized dystonia
  • Benztropine– It has anticholinergic and antihistaminic effects. It blocks presynaptic dopamine uptake.

Side effects of anticholinergic drugs
Anticholinergic therapy is better tolerated if the dose is increased very slowly.

Peripheral side-effects

  • Dry mouth
  • Decreased mucus production in the nose and throat resulting in consequent dry and sore throat
  • Decreased sweating leading to warm and red skin
  • Increased body temperature
  • Blurred vision
  • Increased intraocular pressure.

Central side-effects

  • Forgetfulness
  • Visual hallucinations
  • Confusion
  • Behavioural changes

GABAergic drugs
They are effective in reducing the pain associated with dystonia as well as anxiety-exacerbated dystonic postures. GABA is an inhibitory neurotransmitter in the brain and spinal cord. There is abnormal GABA α receptor binding in motor cortices in primary dystonia

Benzodiazepines: primarily affecting the GABAergic system. They increase the frequency of chloride channel opening after binding to GABA α receptors, which eventually facilitates inhibitory signals.

  • Clonazepam
  • Diazepam

Baclofen It is an agonist of GABA β receptors at presynaptic terminals of excitatory glutamatergic neurons, and at postsynaptic sites of inhibitory interneurons in the spinal cord. It reduces neck muscle contractions.

Dopaminergic drugs
They stimulate D2 receptors. There is marked, long-term benefit with low-dose levodopa.

Medications primarily affecting the dopaminergic system can be divided into
1) Levodopa and
2) Dopamine reducing medications such as
presynaptic dopamine depletors (such as tetrabenazine [TBZ]) and
postsynaptic dopamine blocking agents (DRBAs such as clozapine, quetiapine and typical neuroleptics).

Botulinum toxin injection: It is injected the abnormally contracting muscles every 3 months and is generally accepted as the first treatment of choice. It is an acetylcholine release inhibitor and neuromuscular blocking agent. It binds to receptor sites on motor nerve terminals. After uptake it inhibits the release of acetylcholine & blocks transmission of impulses in neuromuscular tissue.
Anti-depressants may be used but the effect is usually mild and modest.