Spasmodic torticollis symptoms. Spasmodic torticollis in adults: treatment and prevention

Spasmodic torticollis or cervical dystonia is a neurological disease that is accompanied by an increased tone of the neck muscles, as a result of which the head assumes 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 talk about the 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 in the musculoskeletal system after congenital dislocation of the hip and clubfoot. According to statistics, there is one patient suffering from spastic torticollis per 10 thousand of the population.

Causes

Modern medical research indicates that the cause of the disease is a violation of the extrapyramidal system of the brain, which is responsible for stereotyped movements. In other words, such movements arise without the willful efforts of a person, brought to automatism in the process of development of the organism to facilitate life. In case of violation in the extrapyramidal region of the brain of synaptic transmission between nerve cells and the physiological synthesis of mediators - mediators of the conduction of a nerve impulse - an increased tone (hypertonicity) of the controlled neck muscles is formed.

Causes of pathology in adults:

• neuroinfections;
• drug intoxication;
• harmful conditions professional activity;
• violation cerebral circulation;
• cerebral paralysis;
• brain tumors;
• endocrine disorders (hyperthyroidism);
• chorea;
• genetic factor.

With torticollis, the tone of the sternocleidomastoid muscle increases

IN last years the role of cervical osteochondrosis in the formation of cervical dystonia according to the reflex type, the so-called peripheral form, has been proven.

Causes of pathology in infants:

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

In the congenital form of the disease, pathological changes are diagnosed in the first months after the birth of a 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 spastic torticollis usually debut with recurrent pain in the neck, which over time become permanent. Due to hypertonicity of the sternocleidomastoid, trapezius, belt muscles of the neck and upper half of the body, the head assumes a non-physiological position and is tilted towards the pathology. In addition to the tilt, the head turns in one direction or another, which makes it possible to distinguish the following forms of the disease:

• torticollis - a pathological turn of the head towards hypertonicity;
• retrocollis - pathological tilting of the head;
• antecollis - pathological head tilt or neck forward;
• laterocollis - abnormal tilt of the head towards the shoulder.

Usually there are mixed forms of the disease, when the head takes a non-physiological position with an inclination and rotation to the side.

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

Appearance child with congenital torticollis

Cervical dystonia is characterized by involuntary movements of the neck muscles. Depending on the specifics of the reduction muscle fibers distinguish the following forms of the disease:

• tonic - the muscles are in constant tone, tense, head movements have a small amplitude and are almost invisible;
• clonic - the muscles contract, there is a large amplitude of head movements by the type of repeated nods or turns.

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

The manifestation of congenital spastic torticollis with untimely diagnosis and treatment 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 there is a pathological tilt of the head towards the lesion.

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;
• disruption of the chest organs;
• limitation of head movement;
• asymmetry of the face (eyes, eyebrows, ears);
• clavicle deformity;
• elevated position of the shoulder girdle on the side of the lesion;
• 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 the back of the head with torticollis, the head takes a physiological position

Symptoms of the disease are less pronounced during sleep, in the supine position and with the support of the head with hands. Clinical manifestations are aggravated by walking, performing daily work, under conditions of emotional stress 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 violate the social adaptation of patients, cause obvious cosmetic defects of the head and neck, and lead to disability.

Medical tactics

Conservative therapy of the disease has difficulties due to the short-term or insufficiently effective action of drugs, 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 muscles of the neck, soothe nervous system. If it is not possible to achieve a positive effect with drugs, they resort to surgical intervention.

Conservative therapy

For the treatment of infants, drugs are used according to strict indications in acceptable age dosages, massage with thermal procedures, proper bedding, immobilization of the neck with a plaster collar.

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

• anticholinergics or central anticholinergics - norakin, cyclodol, akineton;
• anticonvulsants - clonazepam, finlepsin;
• muscle relaxants - baclofen, mydocalm;
• antidepressants - azafen, prozac, toloxatone;
• botulinum toxin preparations - botox, xeomin, dysport.

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

After a course of drug therapy, the recovery period of treatment begins. It aims to consolidate the positive effect achieved medicines. In the last decade, methods of manual impact on the collar zone (neck, shoulder girdle, upper back) and reflexotherapy according to ancient Chinese methods have been used with high efficiency. Relaxing massage and acupuncture (acupuncture) eliminate pain, activate metabolic processes in the muscles, restore normal motor activity neck, improve blood flow through the cerebral and vertebral arteries.

The final stage of therapy includes therapeutic exercises to strengthen cervical spine and increase the elasticity of muscles in the neck and torso. This helps to eliminate the pathological motor stereotype formed during the manifestation of symptoms of torticollis - 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 will of patients to recover and normalize emotional state.

Botulinum toxin preparations are used for modern drug therapy of torticollis.

Surgery

Surgical methods of treatment are prescribed for the ineffectiveness of conservative therapy and the severe course of the disease. 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 in modern medicine are rarely performed due to the occurrence of complications. An innovative method of surgical treatment is considered to be stereotaxic operations that effectively relieve muscle spasm of the neck by directly affecting the extrapyramidal system.

The procedure consists in conducting electrodes to the responsible areas of the brain through small holes in the skull. A high-frequency current of 130-150 Hz is supplied to the brain tissues through the electrodes, which prevents the formation of pathological nerve impulses and eliminates the symptoms of cervical dystonia. The positive experience of such surgical interventions proved the possibility of effective treatment of the disease. Stereotactic operations do not cause severe complications, are characterized by a quick recovery period, are prescribed by an adult and a patient childhood.

Spasmodic torticollis disrupts the normal way of life, makes it difficult to self-service, makes it impossible to work, causes deep emotional trauma due to cosmetic defects of the face. The progression of the disease leads to the defeat of large muscle groups of the neck and trunk, which worsens the quality of life and contributes to the emergence of 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. Early treatment prevents the development of complications and improves the prognosis for recovery.

A healthy person never thinks about which muscle groups he needs to contract or relax so that the head is located clearly in the midline of the body. The correct position is provided by a certain tone of the cervical muscles, which is not felt in any way and is regulated exclusively by the brain against the will of the individual.

For a number of reasons, congenital or acquired, the head may take an unnatural forced position due to the predominance of contraction of the neck muscles on one side. This condition is called spastic torticollis.

This is a rather serious neurological pathology, which is not deadly, but contributes to a significant impairment of the patient's quality of life. What is the peculiarity of this condition and are there ways to get rid of the disease?

General information

Spasmodic torticollis or cervical dystonia is a collective term that combines many varieties of focal dystonic.

Simply put, this pathology is a violation of the normal tone of some paired muscles of the neck and shoulder girdle, which leads to the formation of an incorrect head position in relation to the body.

The development of pathology is based on disorders in the extrapyramidal system of the brain, located in the cerebral hemispheres and the trunk. This structure controls movements, participates in the maintenance and posture of certain parts of the human body.

Violation of the normal process of transmission of nerve impulses leads to their excessive flow, hence the constant or periodic contractions of the muscles on one side of the neck, which changes the position of the head and makes normal movements difficult.

The prevalence of this pathology in adults does not exceed 10 people per 100 thousand of the population. A high incidence of the disease in women of working age is characteristic.

In newborns, torticollis ranks third after such ailments as congenital hip dysplasia and clubfoot.

It should be noted that cervical dystonia is an acquired neurological disease, in contrast to the torticollis, which is associated with congenital anomalies in the development of the cervical muscles or vertebrae. Such a pathological situation is noticeable immediately after birth and is called true torticollis of the newborn. If the incorrect installation of the head of babies is associated with muscle hypertonicity, then it is called false torticollis.

Why does it happen?

Improper formation of impulses in the extrapyramidal structures of the brain occurs for quite specific reasons. They may differ depending on the age category of patients.

In adults, spastic torticollis predominates, acquired as a result of the following situations:

In newborn babies, spastic torticollis is most often associated with trauma during childbirth. In addition, such unfavorable factors as:

• breech presentation of the fetus in the womb;
• the presence of chronic intrauterine hypoxia syndrome;
• toxic effect on the fetus of infection or medication;
• incorrect conduct of labor activity.

Clinical manifestations

The main symptom of spastic torticollis is visible to the naked eye - this is a pathological setting of the head and neck in relation to the body. It is characteristic that this deviation is hardly noticeable at rest, during sleep and in the horizontal position of the body.

On the contrary, torticollis reaches its maximum severity in the vertical position of a person, as well as when walking and during stressful situations. Each patient with cervical dystonia has certain situations in which they look better, such as walking down stairs.

The onset of the disease can be acute or more often gradual with previous pain in the cervical region. In this case, more than a dozen different muscle groups of the neck and shoulder girdle are involved in the pathological process, the largest of them is the sternocleidomastoid.

Depending on the predominance of tone in a particular muscle, the following variants of cervical dystonia are distinguished:

• rotation of the head in one direction (like torticollis);
• the head is pushed forward (antecollis variant);
• backward deviation (type of retrocollis);
• tilt of the head to the shoulder (variant of laterocollis);
• combined form.

At the initial stage of the disease, an independent return of the head to the median position is possible. As the pathology progresses, the patient has to resort to the help of his hands for this. Then comes the hypertrophy of the affected muscles, the impossibility of independent rotation of the head, and pain appears.

According to the nature of muscle contractions, tonic, clonic and mixed variants of cervical dystonia are distinguished. The clonic form is characterized by noticeable involuntary movements in the form of nods or tilts.

In infants, spasmodic torticollis may not show much in the first weeks of life. Only an experienced doctor can identify it.

Over time, the baby in the middle or lower part of the neck appears thickening and thickening on one side. The child reacts by crying to the examination. Further, the baby's head will deviate more and more to the problem side, and his face to the healthy one. Over time, the affected area may atrophy, and the skull may become deformed.

Diagnosis and treatment

If torticollis is suspected, the child should be examined by a neurologist and a pediatric orthopedist, adults are referred to a neurologist. Clarification of the diagnosis is necessary to determine the tactics of treatment. For this, additional research methods are being carried out - radiography of the cervical spine, or, if necessary, resort to.

The main goal of therapeutic measures is to improve the quality of life of a patient with cervical dystonia. The pathology cannot be radically cured, but it is possible to alleviate the condition and improve the social adaptation of the patient with the help of conservative and surgical methods of medical care.

Conservative treatment of spastic torticollis includes the appointment of the following groups of drugs to relax and stretch the affected muscle:

• muscle relaxants- Tolperison, Baklosan;
• anticholinergics central action - Trihexyphenidil, Norakin;
• antiepileptic and anticonvulsant drugs — , ;
• antidepressant drugs- Fluoxetine, Azafen;
• botulinum toxin preparations- Botox, Dysport.

Botulinum toxin is injected intramuscularly into the affected area. Failures in this case can be explained by a violation of the normal anatomical relationships between the muscles in cervical dystonia. Therefore, it is necessary to control ultrasound when performing injections. This therapy provides an effect for about six months, followed by the need for repetition.

Schemes of conservative treatment necessarily include manual therapy, massage, acupuncture, the use of orthopedic structures (collars).

Surgical methods are used when previous therapy is ineffective. At present, experience has been accumulated in the use of stereotaxic operations to bring electrodes to the structures of the extrapyramidal system in order to inhibit pathological impulses.

Spasmodic torticollis disrupts the usual rhythm of life, deprives a person of normal performance, causes psychological trauma due to aesthetic defects. A progressive disease always leads to damage to a large number of muscles of the neck and trunk, which contributes to the formation of disability.

At the same time, children may lag behind in physical and mental development, their skull is deformed, and scoliosis is formed in the cervicothoracic region. Only early treatment can prevent the development of complications and significantly improve the prognosis for life.

Spasmodic torticollis in adults is a disease of the nervous system in which the neck, and accordingly the head, occupy an unnatural position. Most often, the head leans towards the shoulder and simultaneously turns in the opposite direction from this shoulder. As a rule, the symptoms are aggravated during walking and during periods of excitement. The severity of the disease can be different: from mild discomfort and an almost imperceptible turn of the head to a severe spasm, in which it becomes difficult for a person to serve himself. Most often, the disease affects a person at the most "blooming" age of 20-40 years. This age range accounts for about 90% of cases. This often applies to both men and women.

There are tonic, clonic and tonic-clonic forms of torticollis. The last, mixed type is most often noted. With a tonic form, the muscles are in tension almost all the time. With clonic muscles, they contract with sharp spasms and relax again. It looks like pretentious, unnatural head jerks. The clonic form attracts the attention of others to a greater extent, but it rarely causes pain, which is inherent in the tonic form due to the constant pathological muscle tension. A distinctive feature of the disease is a decrease in muscle tone when using the so-called corrective gestures. It can be light touches of the forehead, chin, nose, ear and other points on the patient's head.

Causes of spastic torticollis

The causes of the disease are not fully understood. For a long time it was believed that the disease has a neurotic (mental) nature. IN Lately neurologists are inclined to the version of organic disorders in the basal ganglia of the brain, which leads to an imbalance in the extrapyramidal system, which causes pathological tension in the muscles of the neck and shoulder girdle. Also, spastic torticollis can be the result of injuries and severe nervous shocks. However, none of the versions has a clear confirmation.

Treatment of spastic torticollis

Is it possible to cure spastic torticollis in an adult?This complex issue to which no definite answer can be given.Treatment of spastic torticollis in adults, unlike pediatric torticollis, is a very difficult task, and most specialized doctors tend to believe that this disease is incurable. However, in medical practice there are references to the complete regression of the disease and spontaneous and sometimes very long remissions, most of which, unfortunately, end after a different period of time and the disease returns, often transforming. New muscles may be affected, and muscles that were previously tense, on the contrary, are no longer involved in the pathological process.
For the treatment of cervical dystonia, botulinum toxin injections into target muscles are most commonly used. For this, drugs are usually used: Botox, Dysport, Xeomin. The drug locally blocks neuromuscular transmission. After an injection within one to two weeks, muscle tension decreases. In different patients, the severity of the effect varies significantly. Sometimes there is complete resistance to the treatment.And, unfortunately, the effect of injections does not last long and after 3-4 months the procedure has to be repeated. The success of the procedure largely depends on the experience of the doctor.
Treatment of torticollis with botulinum toxin is usually preceded by a long period of drug therapy, which is rarely effective. The following drugs are used: sirdalud, baclofen, clonazepam, midokalm.
Often psychotherapy, hypnosis, correct settings and faith in a cure. This, at least, helps to reduce the intensity of the manifestation of the disease.

AND Sometimes stereotaxic surgery is appropriate for spastic torticollis. However, this is an expensive procedure with unpredictable risks for the patient and is performed in the most severe cases, when the patient cannot take care of himself and none of the conservative methods of treatment brings a satisfactory result.

Added:

According to the assurances of many people who are faced with this problem, the emotional background is also of great importance in relation to their disease. Acceptance of the disease, belief in a cure and positive emotions greatly facilitate the patient's condition. Good results are shown by meditation, correct life attitudes.

Medicines have contraindications. It is necessary to consult a doctor!

A neurological disease, accompanied by an increase in the tone of the muscles of the neck and a change in the position of the head, is called cervical dystonia, or spastic torticollis. Most often, the pathology develops between the ages of 20 and 40 years. The representatives of the weaker sex are more susceptible to the disease than men, if we talk about the acquired form of the disease. Signs of the disease may also appear in the first year of a child's life, if this is associated with congenital spastic torticollis. This pathology in children ranks third in frequency of occurrence. The disease is diagnosed in approximately one patient per 10,000 people. Spasmodic torticollis according to ICD 10 has the code G24.3.

Numerous studies have shown that the cause of this disease is a violation of the extrapyramidal system of the brain, it is responsible for stereotyped movements. These are movements for which a person does not need to make an effort. In the process of development of the body, they are brought to automatism to facilitate life. If in the extrapyramidal region of the brain there are violations of the relationship between nerve cells and the physiological synthesis of mediators, an increased tone of the controlled muscles of the neck and shoulder girdle is formed.

Spasmodic torticollis: causes of pathology in adults.

• genetic factor;
• cerebral paralysis;
• violation of cerebral circulation;
• endocrine disorders;
• harmful conditions of professional activity;
• chorea;
• drug intoxication;
• neuroinfections;
• if a person is in an uncomfortable position with the head tilted for a long time.

In recent years, experts have proven the role of cervical osteochondrosis in the development of spastic torticollis according to the reflex type. It is also called the peripheral form.

Causes of torticollis in infants:

• birth trauma to the head;
• intrauterine hypoxia;
• inverted position of the fetus in the mother's womb;
• intoxication at the stage of intrauterine development.

If the pathology is congenital, the diagnosis can be made in the first months of a child's life.

Clinical picture of the disease

In 70% of cases, the disease affects people of working age, is acquired. Pathology manifests itself acutely, but more often within a few months. It all starts with neck pain, over time they become permanent. Due to the hypertonicity of the trapezius, sternocleidomastoid, belt muscles of the neck, the head turns only in a certain direction, this makes it possible to distinguish such forms of the disease:

• laterocollis, if there is a pathological inclination of the head to the shoulder;
• antecollis, occurs when the neck is pushed forward and the head is tilted;
• retrocollis, with it there is a tilting of the head;
• torticollis, in pathological pathological turning of the head occurs in the direction of hypertonicity.

Sometimes there are mixed forms, as a result of which the head turns to the side with a pathological inclination.

At the initial stage of the disease, the patient can change the position of the head, returning it by willpower to the physiological position. When the disease progresses, the patient is forced to resort to the help of hands. Helps to return the head to its place by touching the back of the head, chin, forehead or wrapping a warm scarf with your fingers. In advanced cases, simple movements become impossible, any attempt to turn the head leads to severe pain.

Forms of torticollis

Spasmodic torticollis is determined by involuntary movements of the neck muscles. There are the following forms of the disease, the classification depends on the type of contraction of muscle fibers:

• Clinical. With it, the muscles contract, frequent head movements (turns, repeated nods) are observed.
• Tonic. Muscles are constantly in good shape, head movements are almost imperceptible, they have a small amplitude.

Bilateral torticollis may develop, with it affecting the muscles of the left and right half of the neck. The position of the head remains correct as the symmetrical spasm of the muscle groups balances the position. Ordinary neck movements are painful and difficult. When feeling the neck, there is an increased sensitivity of the muscles, seals are detected.

Less pronounced signs of the disease, in the supine position, during sleep, with the support of the head with hands. Symptoms are aggravated by walking, under conditions of stress and emotional tension, while performing daily work. With the progression of the disease, healthy muscles are involved in the pathological process, which worsens the prognosis. In severe cases of the disease, the social adaptation of patients is disturbed, which leads to the appearance of disability.

The development of torticollis in a child

With untimely diagnosis and treatment, spastic torticollis progresses, causes severe physiological disorders, and as a result, a delay in the development of the child occurs.

In the area of ​​increased tone of the neck muscles in the first month of a baby's life, a dense roller is formed. Then there is an incorrect inclination of the head to the damaged area.

Due to the active development of the child, the progression of the pathology, the disease leads to the following consequences:

• the work of the chest organs is disturbed;
• there is a deformation of the bone structure of the sternum and skull;
• clavicle deformity;
• pinching of the cervical vertebrae;
• delayed physical and mental development;
• osteopathy;
• scoliosis of the thoracic and cervical spine;
• facial asymmetry;
• persistent shortening of the sternocleidomastoid muscle;
• on the side of the lesion, there is a rise in the shoulder.

Treatment methods for torticollis

Treatment methods can be different, they are selected by the doctor individually, based on the severity of the disease. After the examination, the doctor will suggest a conservative method of treating the disease, although conservative therapy has difficulties in applying. This is due to the fact that the effect of medications has a short effect, their intake requires constant monitoring and repeated courses of treatment. The doctor will prescribe drugs that calm the nervous system. In the event that a positive effect cannot be achieved, surgical treatment is required.

Conservative treatment

If pathology in infants, in newborns, how to treat? Treatment of torticollis in children consists in the use of drugs according to strict indications in the dosage selected by the doctor. It is also necessary to properly place the child in the crib, massage with thermal procedures, and immobilize the neck with a plaster collar.

In the treatment of spastic torticollis in adults, the following drugs are prescribed:

• Muscle relaxants (Mydocalm, Baclofen).
• Botulinum toxin preparations (Xeomin, Botox, Dysport).
• Antidepressants (Prozac, Azafen, Toloxatone).
• Anticonvulsants (Finlepsin, Clonazepam).
• Cholinolytics (Cyclodol, Norakin, Akineton).

The use of drugs based on botulinum toxin is an innovative method of drug treatment. They are injected into spasmodic muscles. It induces normal functioning and relaxation for up to 6 months. When the period of action ends, the drug is administered again, such treatment is carried out for several years.

After a course of treatment with medications for spastic torticollis, treatment is prescribed aimed at recovery. It is mandatory, since it is aimed at consolidating the positive effect that has been achieved by drugs. Methods of manual therapy on the collar zone and reflexology are highly effective. It should be borne in mind that these procedures can only be performed by highly qualified specialists, otherwise the manipulations will cause harm.

Acupuncture and relaxing massage will help eliminate pain, restore normal motor activity of the neck, activate metabolic processes in the muscles, improve blood flow through the vertebral and cerebral arteries.

At the end of the conservative method of treatment, individually for the patient is prescribed physiotherapy, aimed at strengthening the cervical spine and muscles, as well as increasing the elasticity of muscles in the trunk and neck. This helps to eliminate the pathological process that is formed during the detection of symptoms of torticollis. Facial tics, involuntary head movements, shoulder elevation on the side of increased muscle tone will disappear. To improve the emotional state and recovery, auto-training and psychotherapy are prescribed.

Treatment of torticollis with folk methods

Alternative methods cannot completely cure torticollis. But herbal medicine can alleviate general state patient, relieve tension, relax muscles, normalize metabolic processes in the body, eliminate the causes of neuromuscular excitation.

1. Juniper berries have properties to restore blood circulation. In the case of spastic torticollis, they should be consumed raw, eating one berry on an empty stomach, the amount should be gradually increased to twelve.
2. You can prepare a decoction of lavender, berries and bark of viburnum, linden flowers. Bay 2.5 st. spoons of herbs with a glass of water, the mixture is brought to a boil, then insisted for 2.5 hours. 100 grams are drunk three times.
3. Herb motherwort yarrow, pharmacy chamomile, mint, kernels walnut in equal doses are placed in boiling water. They let it brew. Drink as a sedative morning and evening.
4. Effective ointment of pork fat and lilac buds (5:1). It is necessary to melt the fat, add the kidneys there, cook in a water bath for 60 minutes. The cooled ointment is rubbed into the muscles of the neck and shoulders up to 4 times a day.
5. In the morning, they drink a mixture from a glass of milk, where mummy (0.3 g) and honey (1 tablespoon) are added.

Surgical treatment

With the ineffectiveness of conservative therapy, one has to resort to a surgical method of treatment. Classic way surgical intervention - suppression of the sternocleidomastoid muscle and the nerve that leads to the muscles. Such operations are performed quite rarely, since there is a high risk of complications. In the figure - the operation of plastic lengthening of the sternocleidomastoid muscle according to I. E. Hagen-Thorn, is used for congenital torticollis in children.

Stereotactic operations are an innovative method of modern medicine. By direct action on the extrapyramidal system, spasm of muscle groups is effectively relieved. Electrodes are inserted through small holes in the skull to the responsible areas of the brain. A high-frequency current of no more than 150 Hz is supplied to the brain tissues through the electrodes. It eliminates the symptoms of cervical dystonia (spastic torticollis) and prevents the formation of pathology of nerve impulses. Such operations do not cause complications. After them, a long recovery period is not required. Stereotactic operations can be prescribed for young patients and adults.

Spasmodic torticollis makes it difficult to self-service, disrupts the normal way of life, and makes it impossible to work. The progression of the pathology can lead to damage to large muscle groups, deprive a person of normal movement. If treatment is not started on time, the consequences will be very unfavorable. Timely conservative therapy will help prevent disability.

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2010 (Order No. 239)

Spasmodic torticollis (G24.3)

general information

Short description

Spasmodic torticollis(torticolis spastica) - focal unilateral paroxysmal dystonia, manifested by stereotypical tonic or tonic-clonic convulsions of the neck muscles (sternocleidomastoid, trapezoid, etc.), while the head turns in the opposite direction and is somewhat tilted forward or thrown back.
Muscle spasms are often associated with emotional stress, appear in series, repeated many times every day for several weeks or months, after which remission of an unpredictable duration is possible.

Spasmodic torticollis is the most common variant of dystonia. Depending on the position of the head, torticollis is distinguished, characterized by a turn of the head to the side, laterocollis - with a tilt to the side, anterocollis - with an anterior tilt, retrocollis - with a backward tilt, as well as a combined version of cervical dystonia.

Protocol"Spastic torticollis"

ICD-10 codes: G24.3

Classification

Classification: spastic torticollis.

Dystonia:

1. Local: blepharospasm, writing spasm, dysphonia.

2. Segmental: spastic torticollis, crural, brachial.

3. Generalized: hemidistonia, torsion spasm.

Clinical classification:

1. Paroxysmal dyskinesia (attacks from 10 to 50 minutes).

2. Nocturnal paroxysmal dystonia.

3. Delayed (PE, TBI, stroke).

4. Iatrogenic.

5. Peripheral.

6. Myoclonic.

7. Spasmodic torticollis.

8. Torticollis.

9. Laterocollis.

10. Anterocollis.

11. Retrocollis.

Diagnostics

Diagnostic criteria

Complaints and anamnesis: muscle spasms in the neck, violent turning of the head, emotional lability, head tremor.

Physical examination: neurological status - torticollis, tonic convulsions in the muscles of the neck. The patient's attempt to actively resist the violent turn of the head, trying to turn it in the opposite direction, only increases the intensity of the convulsions. However, touching a finger to the lower jaw or cheek (corrective gestures) on the side to which the head spontaneously turns during an attack sometimes noticeably reduces muscle tension.

In those who are ill for a long time, on the side opposite to that to which the head turns during an attack, hypertrophy of the sternocleidomastoid muscle, trapezius muscle and deep muscles of the neck occurs. Approximately one third of patients develop scoliosis, 20% - secondary cervical radiculopathy. In some patients, it is possible to observe the transformation of spastic torticollis into torsion dystonia, which can be regarded as one of the arguments that allow us to recognize the pathogenetic commonality of these clinical forms of extrapyramidal pathology. However, there are also separate clinical observations in which it is proved that spastic torticollis may be due to chronic irritation of the accessory nerve.

Laboratory research: general analysis of blood and urine without pathology.

Instrumental research:

1. Electromyography (EMG). Recording electromyograms of the muscles involved in hyperkinesis allows obtaining high-amplitude bilateral discharges, EMG is used to objectify the disease, exclude simulation. In extrapyramidal disorders, resting activity is recorded, represented by an interference curve. Against this background, correct or irregular in rhythm modulations are observed with a frequency of 6-12 per second.

2. Electroencephalography (EEG).

Indications for expert advice:

1. Orthopedist.

2. Psychologist.

3. Speech therapist.

4. Optometrist.

Minimum examination when referring to a hospital:

General analysis blood;

General urine analysis;

ALT, AST;

Feces on eggs worm.

The main diagnostic measures:

1. Complete blood count (6 parameters).

2. Electroencephalography.

3. Examination by an ophthalmologist.

4. Orthopedist.

5. EMG - electromyography.

6. Magnetic resonance imaging of the cervical spine.

7. Prosthetist.

Additional diagnostic measures:

2. Ultrasound of the abdominal organs.

Differential Diagnosis

sign	Pathogenesis	Neurological status	Flow
Spasmodic torticollis	Chronic irritation of the accessory nerve, the pathogenic basis is considered to be muscle spasm-antagonists, i.e. involuntary muscle tension that opposes the desired movement	Muscle spasms in the neck, violent turning of the head, tonic spasms in the muscles of the neck	Recurrent
Torticollis of peripheral origin as a result of compression of the root of the accessory nerve (XI), cranial nerve	Compression of the root of the accessory cranial nerve by a pathological process: vascular or craniovertebral anomaly, atlanto-occipital subluxation, tumor or adhesion	Falling head symptom with predominant fall towards the weaker muscle
Vertebrogenic spasm of the cervical muscles (caused by pathology of the spine)	Cervical osteochondrosis, herniated discs, syringomyelia, tumor of the cervical region, malformations at the level of the medulla oblongata and spinal cord, juvenile rheumatoid arthritis	Radiculopathy, myelopathy, neck and arm pain, torticollis	Depending on the underlying disease

Treatment

Treatment tactics

Treatment goals:

1. Suppression of convulsions, tension in the affected muscles of the neck.

2. Reduce torticollis, soreness in spastic neck muscles.

Non-drug treatment:

1. Psychotherapy.

2. Compliance with the regime of the day: avoid stressful situations, mental overload, long sessions on a personal computer.

3. Massage of the collar zone.

4. Exercise therapy - group classes.

5. Physiotherapy - ozocerite applications.

6. Phytotherapy - extract of valerian, motherwort, passionflower, hops, lemon balm, mint.

7. Self-control of hyperkinesis.

Medical treatment

Muscle relaxants:

1. Tolpirisone hydrochloride (mydocalm), for children over 3 months of age. up to 6 years at a daily dose of 5-10 mg / kg in 2-3 doses; at the age of 7-14 years - at a daily dose of 2-4 mg / kg.

2. Tizanidine hydrochloride (Sirdalud), a centrally acting muscle relaxant.

3. Baclofen 30-60 mg/day.

4. In a number of patients, benzodiazepines are effective: clonazepam in combination with muscle relaxants.

If the above funds did not give an effect, neuroleptics are prescribed - haloperidol 1.5-3 mg / day, the drug is prescribed in intermittent courses (with exacerbations) or for a long time in the minimum effective dose.

Most effective method treatment of focal dystonia are injections of botulinum toxin preparations (dysport) into the muscles involved in hyperkinesis, causing partial paresis of these muscles and thereby eliminating dystonia for several months, after which the injection has to be repeated. Doses depend on the number of muscles involved. Sternocleidomastoid (50-100 units), scalene (25-50 units), levator scapula (4-6 units), belt (25-75 units), trapezoid (25-100 units). The total dose is up to 4-6 units / kg, the effect is from 60 to 90%.

General strengthening therapy: B vitamins, folic acid, magnesium preparations.

Sedative therapy: noofen, grandaxin, novo-passit.

Preventive actions: observance of the daily regimen - sufficient sleep, rest, prevention of infections, traumatic brain injuries, mental overload, long-term work on a personal computer, watching television programs.

Further management: creation of conditions for normal learning, successful socialization of the child and the education of self-control.

Basic medicines:

1. Actovegin 2 ml 80 mg

2. Glycine, tablets 0.1

3. Hopantenic acid (Pantocalcin), tablets 0.25

4. Novo-Passit, coated tablets, oral solution

5. Noofen, tablets 0.25

6. Pyridoxine hydrochloride - ampoules 1 ml 5%, vitamin B6

7. Tolpirisone hydrochloride (Mydocalm), tablets 50 mg

8. Folic acid tablets 0.001

9. Cyanocobalamin, 1 ml ampoules 200 and 500 mcg, tolpirisone hydrochloride (Mydocalm), 50 mg tablets

Additional medicines:

1. Aevit capsules

2. Baclofen tablets 10 mg, 25 mg

3. Botulinum toxin (Dysport), bottle 500 IU

4. Vincamine (Oxybral), capsules 30 mg

5. Haloperidol tablets 1.5 mg, 5 mg, 10 mg and 20 mg

6. Diazepam, 2 ml ampoules 5%

7. Clonazepam, tablets 2 mg

8. Magnesium lactate + pyridoxine hydrochloride - magne B6

9. Thiamine bromide, ampoules 1 ml 5%

10. Tizanidine hydrochloride (Sirdalud), 2 and 4 mg tablets

11. Trihexyphenidyl (Cyclodol) 2 mg tablets

12. Chlorprothixene 15 tablets

Treatment effectiveness indicators:

1. Regression of tonic convulsions, muscle spasm in the muscles of the neck.

2. Reducing torticollis.

3. Increased emotional tone, mood, performance of the patient.

Hospitalization

Indications for hospitalization (planned): unilateral paroxysmal dystonia of the neck muscles.

Information

Sources and literature

1. Protocols for the diagnosis and treatment of diseases of the Ministry of Health of the Republic of Kazakhstan (Order No. 239 of 04/07/2010)
   1. E.I. Gusev, G.S. Burd, A.S. Nikiforov. Neurological symptoms, syndromes, symptom complexes and diseases. Moscow 1999 D.R. Shtulman. Neurology. Moscow 2005 E.V. Schmidt. Handbook of neurology. Moscow 1989 V.P. Zykov. Pathology of the extrapyramidal system in children. Moscow 2006 Gerald M. Fenichel. Pediatric neurology. Moscow 2004 L.R. Zenkov, M.A. Ronkin. Functional diagnosis of nervous diseases. Moscow 1999

Information

List of developers:

№	Developer	Place of work	Job title
	Kadyrzhanova Galiya Baekenovna		Head of department
	Serova Tatyana Konstantinovna	RCCH "Aksay", psycho-neurological department No. 1	Head of department
	Mukhambetova Gulnara Amerzaevna	KazNMU, Department of Nervous Diseases	Assistant, Candidate of Medical Sciences
	Balbaeva Aiym Sergazievna	RCCH "Aksai", psycho-neurological department No. 3	Neurologist

Attached files

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