Torticollis head tremor. Spasmodic torticollis. Development of torticollis in a child

Muscular dystonia (MD) is a syndrome of damage to the central nervous system with a predominant involvement of extrapyramidal formations. They are movement disorders characterized by involuntary and irregularly repeated muscle contractions that cause elaborate, stereotypical movements or pathological postures. The formation of a functional deficit in patients (blindness with blepharospasm, inability to hold the head in a midline position with spastic torticollis, writing impairment with writer's cramp, etc.) complicates their social adaptation and leads to early disability.

In the republic at the beginning of 2007, 428 patients with muscular dystonia were observed (the overall incidence rate was 5.5 per 100 thousand adults). The most common forms are spastic torticollis (74.1% of cases), blepharospasm (12.6%). The rarity of the disease is one of the reasons for the difficulties in diagnosing and treating muscular dystonia.

Classification

According to the etiological factor, primary and secondary forms of muscular dystonia are distinguished. Primary (idiopathic) is observed in almost 90% of cases and is often hereditary. The role of a genetic defect in dopamine receptors and anomalies in the structure of proteins involved in neurotransmitter metabolism in the subcortical ganglia are currently being studied. No morphological substrate of the disease was found. Data obtained from neurochemical studies suggest the presence of a neurodynamic defect at the level of the basal ganglia in various forms of MD.

The secondary (symptomatic) form of muscular dystonia includes dystonic syndromes caused by organic brain damage (with cerebral palsy, encephalitis, multiple sclerosis, oncopathology, etc.) or hereditary pathology (Wilson-Konovalov disease, Hallerwarden-Spatz disease, Huntington disease, etc.) , as well as drug-induced dystonic syndromes (for example, after taking antipsychotics).

Depending on the prevalence of the pathological process, the following are distinguished:

Focal dystonia (1 anatomical region of the body is involved), including blepharospasm, oromandibular dystonia, spasmodic torticollis, writer's cramp, ambulatory foot spasm, camptokarmia, spasmodic dysphonia and dysphagia;

Segmental dystonia (2 or more adjacent areas of the body are involved);

Generalized (2 or more non-adjacent areas of the body are involved);

Hemidystonia (limb or whole body involved in hemitype);

Multifocal (2 or more focal forms are combined).

Dystonic movements range from athetosis to rapid myoclonic jerks and may vary over the course of a day or week. Often they decrease when performing any activities, for example, with spastic torticollis - while playing on the computer, riding a bicycle. Sometimes such paradoxical kinesias cause diagnostic difficulties.

Diagnostics

For all forms of the disease, there are 9 uniform diagnostic criteria:

Presence of dystonic posture;

Dissociation of dysfunction of the affected area (for example, with writer's cramp, the patient cannot write with a pen, but writes freely on the board with his hand);

Dependence of clinical manifestations on body position and physical activity (aggravated when standing and walking);

Dependence of clinical manifestations on the emotional state;

The use of corrective gestures that can reduce the severity of dystonia (for example, patients with spasmodic torticollis sometimes prevent forced rotation of the head by lightly touching the chin with the hand);

Paradoxical kinesia caused by a change in the locomotor stereotype (for example, a patient with dysphonia can sing);

Remissions;

Inversion of functional disorders (for example, the direction of forced rotation of the head with spastic torticollis may change);

A combination of focal forms and their transition from one to another.

A thorough examination is necessary for all children with dystonia and adults with a generalized form.

Stable focal dystonia requires dynamic monitoring by a neurologist, as well as consultation with a highly qualified specialist during the initial diagnosis.

Therapy

Treatment of patients with focal forms can be divided into 3 stages.

1st stage. Identification of patients, prescription of drug therapy (recommended depending on the form of the disease, taking into account concomitant pathology). The duration of the stage is 9–12 months.

For the most common form - spastic torticollis - the following are often prescribed:

Benzodiazepines (clonazepam, diazepex, phenazepam); The drug of choice is clonazepam (2 mg tablets).

Treatment begins with low doses, gradually increasing them;

Anticholinergics (cyclodol, parkopan, akineton) are used for clonic forms and to enhance the effect of clonazepam;

B-blockers (anaprilin, metoprolol) reduce the clonic component;

Neuroleptics (ORAP, Sonapax, Eglonil, which do not cause the development of neuroleptic dyskinesias and parkinsonism) are used for clonic forms and low effectiveness of other drugs; combination with small doses of reserpine prevents the development of tardive dyskinesia during long-term use of antipsychotics;

Muscle relaxants (baclofen, sirdalud, mylocalm) reduce the tonic component;

Dopamine receptor agonists (bromocriptine, mirapex, ropinirole) can be used in any form of MD if other groups of drugs are ineffective;

Anticonvulsants (finlepsin, depakine, orfiril, carbamazepine) reduce the severity of pathological muscle tension.

To reduce the severity of vertebrogenic complications arising from pathological muscle tension, as well as to reduce pain, non-steroidal anti-inflammatory drugs (ibuprofen, diclofenac, meloxicam) are used in average therapeutic dosages.

In the presence of blepharospasm, the combination of clonazepam with atypical antipsychotics (Eglonil, Sonapax) is most effective, and in the case of a combination of blepharospasm with oromandibular dystonia, baclofen.
The role of physiotherapy in relieving pain and muscular-tonic syndromes is important. It includes magnetic, laser and acupuncture therapy; electrophoresis with magnesium sulfate, sodium hydroxybutyrate; paraffin, ozokerite applications; Exercise therapy is important for patients with spasmodic torticollis.

2nd stage. It is prescribed if the measures taken are unsuccessful and includes local injections of botulinum toxin. The drug has been used in neurological practice since the late 1980s. Botulinum toxin is a potent nerve poison that, when administered intramuscularly or subcutaneously, causes chemical denervation of muscles; when administered locally into a muscle, it causes partial paresis, but does not impair its ability to voluntarily contract. The only botulinum toxin preparation registered in the republic is Dysport (used for 6 years; despite the high cost, treatment with botulinum toxin preparations is free).

The decision on the purpose of this method is made by the VKK. It is most effective when a small group of muscles is involved in the pathological process, ineffective in case of writer's cramp, and ineffective in case of generalized muscular dystonia. The method is the therapy of choice in the treatment of focal forms of muscular dystonia (spasmodic torticollis, blepharospasm), as well as facial hemispasm. Injections of the drug are prescribed if there are medical indications, severe forms of the disease and the ineffectiveness of drug treatment for a year. Before administering botulinum toxin, the muscles most actively involved in dystonic spasm are identified during inspection, palpation or using EMG.
Absolute contraindications to the administration of botulinum toxin are pregnancy, breastfeeding, some neurological diseases (myasthenia gravis, Lambert-Eaton syndrome, amyotrophic lateral sclerosis), severe somatic pathology in the decompensation stage; relative contraindications - acute infectious diseases, inflammatory processes at the intended points of administration, taking antibiotics from the aminoglycoside group.

After injection, the risk of adverse reactions is low, and they are transient in nature (pain, hematomas, paresis may be observed at the injection site, when the drug is administered into the neck - dysphagia and dysarthria, when treating blepharospasm - ptosis). Systemic side effects, such as muscle weakness away from the injection site, are extremely rare.

This method compares favorably with the others - medicinal and non-medicinal: the clinical effect is achieved in 85–90% of cases and lasts 2–3 months (longer remissions with less pronounced relapses in the future are also recorded). As a rule, patients need repeated injections of botulinum toxin: for spastic torticollis - 2 injections per year, for blepharospasm - 3-4.
3rd stage. The period of weakening of the effect of the botulinum toxin drug. To prolong the effect of Dysport, stage 1 drug therapy is used - with individual selection of physiotherapeutic treatment and doses of medications.

Surgical treatment is used depending on the form of dystonia at the muscular, neural, radicular or cerebral levels. However healing effect often is transient in nature or associated with dangerous or maladaptive functional disorders (speech, paresis, instability of spinal segments). Therefore, in last years Surgical methods are being resorted to less and less often.

Organization of assistance

There are specialized rooms in the republic for the treatment of patients with muscular dystonia. 12 doctors have been trained and are proficient in the technique of administering botulinum toxin (they have the appropriate certificate). Referrals to the offices are carried out by neurologists from clinics and hospitals. The main indications for referral are blepharospasm, spasmodic torticollis, oromandibular dystonia, as well as other involuntary movements (hemifascial spasm).

Coordinates the treatment of patients with muscular dystonia at the Republican Scientific and Practical Center of Neurology and Neurosurgery. The center’s staff provide advisory assistance during primary diagnosis with a recommendation (if indicated) for the administration of botulinum toxin at the place of residence (in the Republican Scientific and Practical Center, administration is carried out only in complex cases), provide dynamic monitoring of patients in order to assess the effectiveness of therapy on site, monitor the degree of existing functional violations, resolving expert issues.

Modern diagnostics and correctly chosen treatment tactics for focal muscular dystonia can significantly reduce the period of temporary disability, reduce the number of people on disability and the number of hospitalizations in neurological hospitals, and increase the social activity and quality of life of patients.

The material is intended for neurologists.

Sergey LIKHACHEV, director, doctor of medicine. Sciences Professor, Yulia RUSHKEVICH, Senior Researcher, Candidate of Sciences. honey. Sciences, Elena TITKOVA, Head. Scientific and Organizational Department, Ph.D. honey. Sciences, Tatiana CHERNUKHA, Head. emergency department, neurologist. Republican Scientific and Practical Center of Neurology and Neurosurgery

Spasmodic torticollis is a neurological pathology in which the head is in an unnatural position relative to the body due to impaired tone of the muscles of the neck and shoulder girdle.

The disease negatively affects the quality of life, leading to loss of ability to work, severe depression, and social maladjustment.

Description and possible complications

Spasmodic torticollis (or cervical dystonia) is a form of localized hyperkinesis, a condition in which muscles spontaneously contract in response to erroneously transmitted signals from the brain. The pathology is most often recorded in people from 30 to 50 years old, but can also occur in children. According to statistics, this disease occurs in 1 person out of tens of thousands.

The clinical picture of this form of torticollis rarely emerges immediately. Most cases are characterized by a long-term development scenario with a gradual increase in symptoms. The first obvious signs become noticeable after about a year.

Violation of the tone and mode of contraction of one or more cervical muscles forces a person to keep his head unnaturally turned. To the constant pathological tension of the neck, sometimes rhythmic movement of the head in various planes is added, which cannot be controlled.

Spasmodic torticollis is not only a visual defect. Prolonged non-physiological position of the head is a favorable background for the development of various pathologies. Possible consequences of neglect of the disease:

tracheal deformation, respiratory dysfunction;
otitis and sinusitis (from spasmodic muscles);
strabismus, visual disturbances that cannot be corrected by glasses;
migraine;
dystrophy of the cervical muscles;
speech disorders;
pronounced asymmetry of the face, flattening of the skull on the part of the affected muscles;
elevation of the shoulder girdle, deformation of the clavicle;
osteochondrosis of the cervical segment, radiculopathy;
infringement of the lungs and heart by the spine due to developed scoliosis of the thoracic and cervical regions.

Avoiding serious health consequences with dynamically developing spastic torticollis is possible only with the help of early diagnosis and adequate therapy.

Types of disease

Up to several dozen paired muscles of the neck and shoulder girdle can be involved in the hyperkinetic process. Depending on which groups are affected, several types of hyperkinesis are distinguished. If the head and neck are in an unnatural position, then the following terms are applicable to characterize the disease:

torticollis - turn left or right;
laterocollis (lateral form of torticollis) – tilt towards the shoulder (about 90% of all cases). The sternocleidomastoid muscles on one side are affected;
anterocollis (anterior form) – tilt towards the chest (rare). Spasm of the mastoid muscles on both sides;
retrocollis (posterior form) - throwing back. One or both trapezius muscles are in spasm.

If only the head is in an unnatural position, then the following designations are used in the diagnosis:

laterokaput – tilt to the side;
anterokaput – backward bend;
retrokaput – forward bend;
Tortikaput – turning without bending.

If the head is not displaced relative to its axis (spine), then the rotational form of spastic torticollis is diagnosed; if there is a deviation, then the axial form. Combinations of different options are possible. In addition, the head can move left and right and back and forth without bending or turning - lateral and sagittal shifts, respectively.

Occasionally, “torticollis without torticollis” is recorded - a compensated form in which the symptom of muscle hypertonicity occurs on both sides. In this way, the head is visually held in a normal position, but the patient has to carry out movements using the pectoral muscles.

Depending on the predominance of a particular type of seizure, tonic, clonic and mixed forms of torticollis are distinguished. In the first case, the neck is visually static (“locked head”), only the patient feels slight movements. The clonic form is characterized by obvious rhythmic twitching, nodding, or turning of the head. In the mixed form, clonic movements alternate with tonic convulsions. This type is considered the most severe.

Based on etiology, there are two forms of spastic torticollis:

primary (idiopathic). It occurs as an independent disease, often due to genetic predisposition;
secondary (symptomatic). Develops under the influence of provoking factors: neck injuries, tumors, osteochondrosis.

The pathology can be stationary (frozen without further development), slowly or rapidly progressing

Spasmodic torticollis is usually observed in adults and is considered an acquired pathology, but is sometimes found in infants. In the latter case, the disease is not associated with congenital defects in the development of vertebrae and muscles.

Features of spastic torticollis in children early age is the possibility of its self-liquidation (false torticollis). But in any case, medical supervision and corrective measures are necessary to avoid subsequent deformation of the child’s spine and skull.

Reasons for the development of pathology

In the cerebral hemispheres and the oral part of the brain stem there is a structure of anatomical formations that controls motor activity, muscle tone, and is responsible for maintaining a particular posture - the extrapyramidal system. Its neurophysiological disorders, leading to disruption of the synthesis and exchange of neurotransmitters, serve as the basis for the development of spastic torticollis. The result of an excessive, inappropriate flow of nerve impulses is uncontrolled muscle contraction on the right or left side of the neck.

The most common causes spastic form of torticollis in adults:

strokes, severe stress (92% of cases)
neuroinfections: meningitis, encephalitis, poliomyelitis (18% of cases);
head and neck injuries (about 15% of cases).

Less commonly, the pathology is provoked by the following reasons:

brain tumors;
drug intoxication (neuroleptics);
long-term preservation of a static head position, associated, for example, with the characteristics of the profession;
hyperthyroidism;
pathological radicular reactions due to pinched nerve endings in osteochondrosis;
insufficiency of blood flow in the cerebral vessels (a common cause of the tonic form of torticollis);
genetic predisposition.

The cause of chronic spasms of the neck muscles in infants is considered to be birth trauma. Predisposing factors:

breech presentation;
intrauterine hypoxia;
disturbances during labor;
intrauterine drug intoxication or infection.

In some cases, it is not possible to identify the exact cause of spasmodic torticollis.

Video

Torticollis

Symptoms

The symptoms of spastic torticollis depend on its form and dynamics of development. Stages of the disease (severity):

Easy. Signs of spasms appear only when walking, active movement, or emotional stress. The head easily returns to its normal position and turns freely in all directions.
Average. The head is fixed in a forced position, but the patient is still able to independently return it to its normal position for a short time. Range of motion is limited. Disability of 2-3 groups is assigned.
Heavy. The head can be straightened only with the help of the hands. The muscles are hypertrophied. Disability of 1-2 groups.
Extremely heavy. Hyperkinesis constantly provokes pain. The head cannot be returned to its normal position. Group 1 disability.

The characteristic symptoms of spasmodic torticollis are visible to the naked eye, which causes serious problems for the patient. Several forms of manifestation are possible:

static unnatural position of the head (extended, tilted, turned or thrown back);
turns in one direction;
nodding or throwing movements;
a combination of nods and turns.

A person with spastic torticollis often involuntarily touches his neck, chin, forehead, and adjusts his collar. Such actions are called compensatory techniques and are observed in 65% of cases. Walking, active physical movement, nervous excitement, and frustration aggravate the clinical picture. In some cases, symptoms arise or disappear only during certain actions, for example: eating, talking, going down the stairs. About 12% of patients complain of rheumatic pain in the back of the neck. Severe pain and weakness in the neck, shoulders, and arms are accompanied by tonic spasms.

Only an experienced specialist can notice spasmodic torticollis in an infant. In most cases, the pathology is diagnosed after 2-4 months, when a pronounced lump appears on the baby’s neck. Gradually the head begins to lean in his direction.

Diagnostics

At the first signs of regular spasms, you should consult a neurologist. Methods for diagnosing the spastic form of torticollis do not differ significantly from the most well-known ones used for other pathologies of a neurological nature. Main types of research:

visual inspection;
palpation of the neck muscles during movement and in static conditions in order to identify their asymmetry of tone and hypertrophy;
general blood and urine analysis;
X-ray;
rheoencephalography (study of the vascular system of the brain);
electromyography (checking the bioelectric activity of muscles);
CT or MRI;
study of brain potentials, testing of acoustic and somatosensory reactions;
myelography.

The medical history also takes into account congenital pathologies that could provoke the appearance of the syndrome.

Treatment

In most cases, it is impossible to completely cure spastic torticollis, so the task of doctors is to eliminate the symptoms as much as possible using conservative or surgical methods.

Conservative therapy is aimed at relaxing and stretching spasmodic muscles. For these purposes, the following means are used:

Injections are the main treatment method. The effect occurs within 5-7 days and lasts about 3.5-6 months. In patients with spasmodic torticollis, the normal anatomical relationship between the muscles is disrupted, so injections are made under ultrasound guidance. Side effects of botulinum toxin: difficulty swallowing (dysphagia), weakness, headache, fatigue. In some forms of torticollis, there is no positive result from Botox injection.

After the reaction to pathological impulses is dulled, the functions of the spine and muscles are restored with the help of physiotherapy. Acupuncture (corporal and auricular), manual therapy (post-isometric relaxation, joint mobilization) is used.

The third stage corrects the pathological motor stereotype – pronounced shoulder elevation. For this purpose, special gymnastics and auto-relaxation techniques are used.

Successful correction triggers a chain of positive changes throughout the entire spine.

In severe forms of spastic torticollis or when pharmacotherapy has not brought positive results, neurosurgical treatment is used. In some cases, positive dynamics are achieved by cutting off the upper cervical roots (their distal parts) of the spinal cord, as well as during surgery for microvascular decompression of the accessory nerve. In some forms of torticollis, the accessory nerve, splenius and levator scapulae muscles (on the oblique side) are suppressed.

The most advanced method is stereotactic intervention on the brain and spinal cord, during which electrodes are implanted through tiny holes in the skull. Thus, the transmission of impulses to the muscles is blocked. Such an intervention does not cause complications.

Prevention measures

To prevent relapses and prevent the disease, it is recommended to learn how to relax qualitatively through auto-training, using orthopedic pillows for sleep. It is important to monitor the correctness of the motor stereotype, avoid misalignment of the shoulders, and take measures to prevent cervical osteochondrosis. It is necessary to avoid situations and movements that can provoke muscle spasms.

Do you notice involuntary movements of your head and neck that you cannot control? IN Lately Is your head turned to the side, forward or backward, and you have to make an effort to return it to its normal position?

Don't hesitate to go to the doctor! Perhaps the cause of these symptoms is spasmodic torticollis, or cervical dystonia. What kind of disease is this and is it possible to cope with it? We’ll tell you in this article!

What is spastic torticollis?

Spasmodic torticollis, or cervical dystonia, is a disease characterized by abnormal tilting or turning of the head due to abnormal muscle tension. There are two types of disease:

Congenital. In this case, it is diagnosed immediately at the birth of the baby.
Acquired. It may occur due to previous illnesses, injuries, incorrect position of the spine or hereditary predisposition. It is not always possible to establish the exact cause of the development of torticollis.

Symptoms of spasmodic torticollis

How to suspect that you have cervical dystonia? Check for the following symptoms:

Incorrect head position. In the first stages of the disease, the patient can, with effort or with the help of his hands, return his head to the desired position. (the disease can begin simply with a head tremor, which can later transform into turning or bending).
Difficulty moving the neck.
Involuntary head movements.
Symptoms intensify with stress, emotional tension usually intensify when walking and moving and decrease or disappear completely when lying down and during sleep.

Common situation? Don't put off visiting your doctor! The earlier the disease is detected, the easier and more effective future treatment will be.

Help yourself get better! Make an appointment with a neurologist at the MART Clinic today!

Treatment of spastic torticollis

There are several treatment methods for spasmodic torticollis:

Conservative treatment:
- Botulinum therapy is currently the “gold standard” for the treatment of cervical dystonia around the world and has the most high level evidence.
- Physiotherapy (as an additional treatment method after botulinum therapy)
- Acupuncture (as an additional treatment method)
- Manual therapy (as an additional treatment method)
Surgical treatment is not used today due to severe complications after surgery. In the absence of effect from conservative treatment or in the case of generalized dystonia. For cervical dystonia it is used quite rarely.

The key to successful treatment of spastic torticollis is timely detection of the disease and an integrated approach to treatment. You will find all this at the MART Medical Center!

Botulinum therapy in the treatment of spasmodic torticollis

Today, botulinum therapy is the most effective and safe way to treat spastic torticollis. Injections of botulinum neuroprotein preparations for spastic torticollis block the transmission of pathological impulses to the muscle and reduce pathological symptoms. Also, with regular injections, it is possible to put the disease into long-term remission.

Treatment of spastic torticollis with botulinum therapy is:

Effective. Pain relief The effect lasts from 3 to 6 months and is achieved through the most accurate selection of muscles and precise targeting of the desired muscle. For this purpose, the drug is administered under ultrasound (US) and electroneuromyography (EMG) control.
Fast and painless! Botulinum therapy is simply an intramuscular injection, after which the patient can go home.

Sign up for the MART Clinic today! We will help you get better! At your service are diagnostics using expert-class equipment, impressive experience of neurologists, modern and effective methods treatments at affordable prices!

Spasmodic torticollis or cervical dystonia is a neurological disease that is accompanied by increased tone of the neck muscles, as a result of which the head takes an unnatural position. The pathological process develops at the age of 20-40 years, and in women 2 times more often than in men. In this case, they speak of an acquired form of the disease. The occurrence of cervical dystonia in the first year of a child’s life is associated with the congenital nature of the disease. In infants, pathology ranks third in the occurrence of defects musculoskeletal system after congenital hip dislocation and clubfoot. According to statistics, per 10 thousand people there is one patient suffering from spastic torticollis.

Causes

Modern medical research indicates that the cause of the disease is a disruption of the extrapyramidal system of the brain, which is responsible for stereotypical movements. In other words, such movements occur without a person’s volitional efforts and are brought to the point of automatism during the development of the body to facilitate life. When synaptic transmission between nerve cells and the physiological synthesis of mediators - mediators of nerve impulses - are disrupted in the extrapyramidal region of the brain, increased tone (hypertonicity) of the controlled neck muscles is formed.

Causes of pathology in adults:

neuroinfections;
drug intoxication;
harmful conditions of professional activity;
cerebrovascular accident;
cerebral paralysis;
brain tumors;
endocrine disorders (hyperthyroidism);
chorea;
genetic factor.

With torticollis, the tone of the sternocleidomastoid muscle increases

In recent years, the role of cervical osteochondrosis in the formation of cervical dystonia of the reflex type, the so-called peripheral form, has been proven.

Causes of pathology in infants:

intoxication during intrauterine development of a medicinal or infectious nature;
incorrect position of the fetus in the uterine cavity;
intrauterine hypoxia;
head injuries during childbirth.

In the congenital form of the disease, pathological changes are diagnosed in the first months after the birth of the child.

Clinical picture

In 70% of cases, the disease is acquired and affects adults of working age. The pathological process begins acutely or gradually over several months. The second option is much more common. Symptoms of spasmodic torticollis usually begin with periodic pain in the neck, which over time becomes constipated. Due to hypertonicity of the sternocleidomastoid, trapezius, splenius muscles of the neck and upper half of the body, the head takes a non-physiological position and is tilted towards the pathology. In addition to tilting, the head turns in one direction or another, which allows us to distinguish the following forms of the disease:

torticollis – pathological rotation of the head towards hypertonicity;
retrocollis – pathological tilting of the head;
antecollis - pathological tilt of the head or forward movement of the neck;
laterocollis is a pathological tilt of the head towards the shoulder.

Usually mixed forms of the disease occur, when the head takes a non-physiological position with tilt and rotation to the side.

On initial stage pathological process, the patient can correct the position of the head and, through an effort of will, return it to the correct position. The progression of the disease forces you to resort to using your hands. Touching your forehead, chin, back of the head with your fingers or wrapping a warm scarf around your neck helps return your head to a physiological position. In advanced cases, free movements of the neck become impossible, turning the head is accompanied by intense pain.

Appearance of a child with congenital torticollis

Cervical dystonia is characterized by involuntary movements of the neck muscles. Depending on the specifics of muscle fiber contraction, the following forms of the disease are distinguished:

tonic – the muscles are in constant tone, tense, head movements have a small amplitude and are almost invisible;
clonic - the muscles contract, a large amplitude of head movements is observed, such as repeated nods or turns.

Sometimes bilateral torticollis develops, in which the muscles of the right and left half of the neck are affected. In this case, the position of the head remains normal, since the symmetrical spasm of the muscle fibers works in opposition to each other. However, normal neck movements are difficult and painful. In any form of the disease, palpation (feeling) of the neck in the affected area reveals compactions and increased sensitivity of the muscles.

The manifestation of congenital spastic torticollis, if not diagnosed and treated in a timely manner, causes severe anatomical and physiological disorders and delays the development of the child.

In the first month of life, a dense ridge forms in the area of hypertonicity of the neck muscles, the skin over the formation is not changed. Then a pathological tilt of the head towards the lesion appears.

Due to the active growth and development of the child in this period of life, as well as the progression of the disease leads to the following consequences:

deformation of the bone structure of the skull and sternum;
organ dysfunction chest;
limitation of head mobility;
asymmetry of the face (eyes, eyebrows, ears);
clavicle deformity;
elevated position of the shoulder girdle on the affected side;
persistent shortening of the sternocleidomastoid muscle;
scoliosis of the cervical and thoracic spine;
delayed mental and physical development.

When you press your hand on the chin or back of the head with torticollis, the head takes a physiological position

Symptoms of the disease are less pronounced during sleep, in a lying position and when supporting the head with your hands. Clinical manifestations intensify when walking, performing daily work, under conditions of emotional tension and stress. It should be remembered that the progression of torticollis involves healthy muscles in the pathological process, which significantly worsens the course of the disease and its prognosis. Severe cases of the disease disrupt the social adaptation of patients, cause obvious cosmetic defects of the head and neck, and lead to disability.

Treatment tactics

Conservative therapy of the disease has difficulties due to short-term or insufficient effective action medications, which requires constant monitoring of the condition and repeated courses of treatment. Prescribe drugs that reduce the excitability of the responsible centers of the extrapyramidal system, reduce the conduction of nerve impulses to the affected neck muscles, and calm nervous system. If it is not possible to achieve a positive effect with medications, they resort to surgery.

Conservative therapy

For the treatment of infants, medications are used according to strict indications in permissible age dosages, massage with thermal procedures, correct styling in bed, immobilization of the neck with a plaster collar.

Treatment of spastic torticollis with conservative methods in adult patients includes the following:

anticholinergics or central anticholinergics - norakin, cyclodol, akineton;
anticonvulsants – clonazepam, finlepsin;
muscle relaxants – baclofen, mydocalm;
antidepressants – azaphene, Prozac, toloxatone;
Botulinum toxin preparations - Botox, Xeomin, Dysport.

An innovative method of drug treatment of the disease is the use of drugs based on botulinum toxin. They are administered by injection into spasmodic muscles, which causes them to relax and function normally over a period of 3 to 6 months. After the specified period, the administration of the drug is repeated, treatment is carried out for many years.

After a course of drug therapy, the recovery period of treatment begins. It is aimed at consolidating the positive effect achieved by drugs. In the last decade, methods of manual influence on the collar area (neck, shoulder girdle, upper back) and reflexology according to ancient Chinese techniques have been used with high efficiency. Relaxing massage and acupuncture (acupuncture) eliminate pain, activate metabolic processes in muscles, restore normal motor activity neck, improve blood flow through the cerebral and vertebral arteries.

The final stage therapy includes therapeutic exercises to strengthen the cervical spine and increase the elasticity of the muscles in the neck and torso. This helps eliminate the pathological motor stereotype formed during the manifestation of torticollis symptoms - involuntary head movements, facial tics, shoulder elevation on the side of muscle hypertonicity. In addition, psychotherapy and auto-training are prescribed, aimed at concentrating the patients’ will to recover and normalizing their emotional state.

For modern drug therapy of torticollis, botulinum toxin preparations are used.

Surgery

Surgical treatment methods are prescribed when conservative therapy is ineffective and the disease is severe. The classic method of surgical intervention is the intersection of the sternocleidomastoid muscle of the neck or the nerve that innervates it. However, such techniques are rarely performed in modern medicine due to complications. Stereotactic operations are considered an innovative method of surgical treatment, which effectively relieve muscle spasm of the neck by directly affecting the extrapyramidal system.

The procedure involves inserting electrodes into sensitive areas of the brain through small holes in the skull. A high-frequency current of 130-150 Hz is supplied to the brain tissue through electrodes, which prevents the formation of pathological nerve impulses and eliminates the symptoms of cervical dystonia. The positive experience of such surgical interventions has proven the possibility effective treatment diseases. Stereotactic operations do not cause severe complications, are characterized by a quick recovery period, and are prescribed for adults and patients childhood.

Spasmodic torticollis disrupts the normal way of life, complicates self-care, deprives one of the ability to work, and causes deep emotional trauma due to cosmetic defects of the face. The progression of the disease leads to damage to large muscle groups of the neck and torso, which worsens the quality of life and contributes to disability. Currently, there are effective methods of conservative and surgical therapy that can maintain the normal condition of patients and eliminate the symptoms of the disease. Timely treatment prevents the development of complications and improves the prognosis for recovery.

Spasmodic torticollis is a form of focal dystonia in which there is a pathologically abnormal position of the head. The occurrence of the disease can be observed regardless of the patient's age. This is a fairly rare disease that occurs most often in women.

Symptoms of pathology

Experts say that spastic torticollis in adults can be observed against the background of dysfunction of the extrapyramidal system. It is the part of the brain that provides automatic stereotypic movements.

An imbalance of neurotransmitters in the extrapyramidal system can lead to impaired body movements. The most common disturbances observed are the contraction of the neck muscles. This leads to excessive impulses, which is why the muscles on one side of the neck are constantly tense and contract frequently. What causes a person to hold their head incorrectly?

Spasmodic torticollis

The occurrence of a pathological condition is often diagnosed against the background of a hereditary predisposition.

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If a person takes antipsychotics for a long period, this can lead to the development of the disease.

Suffered head or neck injuries are quite common cause the occurrence of a pathological condition. With infections in the brain, for example, encephalitis, this disease can also occur. If a person has experienced severe emotional stress or nervous strain, this can also lead to the development of spastic torticollis.

Spasmodic torticollis in adults can occur for a variety of reasons. That is why they are recommended to be as attentive as possible to their health.

Symptoms of the disease

The occurrence of the disease is most often observed in adult patients of working age. In the initial stages, spastic torticollis in adults can occur gradually or immediately become acute. Quite often the disease is accompanied by pain in the cervical spine. Incorrect neck position is the main manifestation of the pathological process, which can be seen with the naked eye. The patient finds it difficult to make involuntary movements of the neck.

The most common occurrence of the disease is observed in all muscles of the neck. The process may partially involve the back muscles - damage to the trapezius, sternocleidomastoid and splenius muscles. Several muscles during development of this disease are characterized by an increase in tone - this is why patients experience incorrect head rotation.

There are several forms of the disease depending on the characteristics of head rotation. If it is turned to the side, then this is called rotation, and if it moves forward and bends forward, then it is called anecollis. Tilting the head to the side is called laterocollis, and tilting the head backward is called retrocollis. Most often, patients are diagnosed with a mixed form.

If at the initial stage of the disease the patient makes appropriate efforts, he will be able to hold his head correctly for a certain time. Next, corrective gestures are used. For example, when certain areas are touched, a correction in the position of the head is observed. To correct the tilt of the head, you need to correct it with your hands.

The disease in adults, which is treated by various methods, is accompanied not only by incorrect position of the head, but also by its pathological movements. As a rule, these movements are involuntary. Since the neck muscles are constantly tense, after a certain time they thicken. Initially, cervical dystonia develops in the area of one or two muscles. After a certain time, the number of muscles involved in the pathological process increases significantly. When pathology appears, most patients complain of pain, especially when turning their head.

In the morning, the manifestation of spastic torticollis is minimal. If the patient is worried or experiences stressful situations, this leads to an increase in the symptoms of the disease. If a person supports his head with his hands or lies down, this leads to a decrease in the manifestation of unpleasant symptoms.

In some cases, with spastic torticollis, bone trembling is observed. Due to prolonged and intense spasms, the patient may experience problems in the cervical spine. In some cases, disc prolapse or compression radiculopathies occur.

With spastic torticollis, patients experience pronounced symptoms. If the patient shows the first signs of the disease, then he needs to seek help from a doctor who can correctly determine the type of disease and prescribe rational treatment.

Diagnostic measures

In treating the disease there is enough important role diagnostics plays. This is because it can be used to determine the type of disease and prescribe the most effective treatment methods. For diagnosis, the patient must consult a neurologist.

X-ray examination

The diagnosis can be formulated only after an X-ray examination, which includes functional tests.

A new diagnostic measure is rheoencephalography. This method makes it possible to study the condition of blood vessels. With its help, you can determine the state of blood supply during turns and tilts of the head. It also makes it possible to analyze the tone of the arteries and the blood supply of blood vessels, the tone of the veins, peripheral vascular resistance and the lability of the vascular walls.

To make a diagnosis, patients are prescribed electromyographic studies. It is also necessary to examine brainstem potentials and somatosensory potentials. Some patients are prescribed transcranial magnetic stimulation to diagnose the disease.

Diagnosis of the disease should be carried out using a set of methods, which will provide the opportunity to make the diagnosis as accurately as possible and determine the method of treatment.

Disease therapy

Treatment of spastic torticollis in adults is a rather difficult process and requires an integrated approach. The pathological changes that underlie the syndrome are very stable, which leads to difficulties in choosing a treatment method. In most cases, pathology therapy is aimed at the use of pharmaceutical drugs that relieve spasms in the neck. For this purpose, patients were prescribed adrenergic agonists and central anticholinergics. Today, Butolotoxin, which belongs to type A, is used to maintain the neck muscles in normal condition. Butolotoxin is injected directly into sore muscles. When the medicine is administered correctly, its effect is observed within 4-6 months.

Baclofen, which belongs to the category of muscle relaxants, is quite effective in treating the pathological condition. Medical specialists also prescribe Clonazepam to patients. Given medicine belongs to the category of anticonvulsant, with the help of which the highest quality muscle relaxation is achieved. In some cases, patients are treated with Carbamzepine or Finlepsin.

In case of spastic torticollis, simultaneous use of the above is allowed medications and anticholinergics. The most effective pharmaceutical drugs in this group include Akineton and Cyclodol. You can also use Norakin. To alleviate the patient's condition, antidepressants may be prescribed.

Postisometric relaxation of the neck muscles, which affects the peripheral focus, is a highly effective method of treating the disease. Also, in the treatment of the pathological process, mobilization of joints in the spinal motion segment is used.

At the third stage of treatment, the disrupted dynamic stereotype is corrected. This stage of therapy is quite long and requires the patient to responsibly follow all the doctor’s recommendations. In order to destroy the stereotype, autorelaxation is used. Physical therapy for spastic torticollis is also effective.

Spasmodic torticollis is a fairly serious disease that has a pronounced pronounced signs. When the first symptoms appear, the patient should visit a doctor. Only a specialist will be able to correctly diagnose and prescribe rational treatment, which will lead to relief of the patient’s condition.

The term "spasmodic torticollis" must be interpreted correctly. The disease can occur as a result of many reasons. Spasmodic torticollis is a pathological condition in which incorrect head position is associated with dysfunction of the neck muscles. They receive excess stimuli from the brain - this leads to an increase in their tone. In this case, spastic torticollis is an acquired disease.