By: Dr. John Conde DC, DACNB Special to the Boca and Delray newspapers
Spasmodic torticollis is a neurological movement disorder characterized by sustained or repetitive muscle contractions resulting in twisting and abnormally fixed postures of the neck primarily. In essence, it is analogous to a severe muscle spasm that does not go away. The aberrant posturing is made worse with physical activity and may progress into adjacent muscle tissue. Pain is very common and the condition does have a negative impact on employment and activities of daily living.
Spasmodic torticollis is considered a type of dystonia which encompasses a wider array movement disorders and intensities throughout the body. Dystonia itself can be classified into three main types which are generalized, focal, and segmental. Generalized is the most dramatic and crippling and affects most or all of the body. However, the most common type of dystonia is the focal variant and it is usually localized to a specific part of the body such as the neck. Spasmodic torticollis is the term utilized when dystonia affects the neck and is exhibited as the classic kissing posture with the neck bent to one side and the head turned to the other side. Other examples of focal dystonia include blepharosapsm which involves the eye lids, oromandibular dystonia which involves the muscles of the jaw and tongue, and writer’s cramp which involves the hands. Lastly, segmental dystonia may affect two adjoining parts of the body.
A promising study in the well-respected journal Brain through Oxford Press in June of 2016 has surfaced which has changed the landscape in the understanding and treatment of dystonia. The study has uncovered what is termed a head neural integrator (cluster of nerve cells) in the top of the brainstem which controls head movements and keeps the head stabilized. It is analogous to another cluster of cells in the brainstem called the ocular motor neural integrator which ensures that the eyes are held steady in different positions of gaze. The abnormalities in head movements seen in dystonia are now attributable to a malfunction of the head neural integrator.
Plasticity is a buzz word in neurology used to delineate the ability of the brain to physically change according to specific stimulation. With this understanding in hand, we know we can change the health of the neural integrator through pin-point activation and thus improve outcomes substantially. Precision diagnosis is of paramount importance in securing positive outcomes for patients with spasmodic torticollis. Incorporating a thorough neurological examination utilizing cutting-edge technology such as visual-oculography (VOG), computerized dynamic posturography (CAPS balance assessment), and Dynavision D2 is crucial in locating the specific faulty brain neural integrator. Targeted neurophysiologic rehabilitation is then prescribed using several modalities such as laser tracking with the head, specific eye movements, interactive metronome, computerized assessment of posture targeting device (CAPS), and manual therapy. These treatments have to be performed diligently with great appreciation for the fragility of the nervous system in patients with spasmodic torticollis therefore no two treatments are ever the same. We are in an exciting time for patients with spasmodic torticollis and generally dystonia with these most recent medical advancements.
Dr. John Conde is a Board Certified Chiropractic Neurologist, one of only one thousand in the country. He holds diplomate status through the American Chiropractic Neurology Board. He provides specialized care for difficult cases of back neck pain, numbness-tingling, vertigo-dizziness balance disorders, fibromyalgia, migraines, AD/HD, autism, and dyslexia. His office is located at the Atlantic Grove in Delray Beach, FL and can be reached at 561-330-6096, firstname.lastname@example.org, and at www.thecondecenter.com