By: Dr. John Conde DC, DACNB Special to the Boca and Delray newspaper
Cervical dystonia is a neurological movement disorder characterized by sustained or repetitive muscle contractions resulting in twisting and abnormally fixed postures of the neck. It is also known as torticollis and is most commonly noted in infants with flattening of the skull or in adolescents that “slept wrong” the night before. However, it is a rather disabling disorder that affects adults as well with a more chronic presentation that may significantly affects day to day activities. 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.
Cervical dystonia or torticollis is considered just one type of a wider array of movement disorders that can be seen 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 or movement in space. The abnormalities in head movements seen in dystonia are now attributable to a malfunction of the head neural integrator. This groundbreaking revelation is thus applied in clinical practice through the modulation of feedback into the impaired neural integrator which changes its activity and promotes health. The take home message being if we can change the activity of these cells through specific activation/therapeutic exercise we can improve or reverse the cervical dystonia.
Plasticity is a medical term 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 cervical dystonia. 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 cervical dystonia therefore no two treatments are ever the same. We are in an exciting time for patients with cervical 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 and can be reached at 561-330-6096, firstname.lastname@example.org, www.thecondecenter.com