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$Unique_ID{BRK04228}
$Pretitle{}
$Title{Spasmodic Torticollis}
$Subject{Spasmodic Torticollis Spasmodic Wryneck Torticollis Tonic Spasmodic
Torticollis Clonic Spasmodic Torticollis Mixed Tonic and Clonic Torticollis}
$Volume{}
$Log{}
Copyright (C) 1986, 1987, 1990, 1991 National Organization for Rare
Disorders, Inc.
213:
Spasmodic Torticollis
** IMPORTANT **
It is possible the main title of the article (Spasmodic Torticollis) is
not the name you expected. Please check the SYNONYMS listing to find the
alternate names and disorder subdivisions covered by this article.
Synonyms
Spasmodic Wryneck
Torticollis
DISORDER SUBDIVISIONS
Tonic Spasmodic Torticollis
Clonic Spasmodic Torticollis
Mixed Tonic and Clonic Torticollis
General Discussion
** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only. It should not be used for diagnostic or treatment
purposes. If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.
Spasmodic Torticollis is a tonic or intermittent spasm of the neck
muscles resulting in rotation and tilting of the head which is often painful.
There are three different varieties of the disorder:
Tonic, causing sustained turning of the head to one side, due to increased
asymmetric muscle tone in one or more neck muscles, Clonic, causing shaking
movements of the head, and Mixed Tonic and Clonic, involving both kinds of
movement.
The cause of this disorder which affects both males and females is usually
unknown.
Symptoms
Onset of Spasmodic Torticollis usually occurs in the 4th or 5th decades of a
person's life. The first symptoms may appear gradually with the head tending
to rotate to one side when a person tries to keep it straight or during a
stressful situation. The symptoms may slowly progress, but they often reach
a plateau after 2 to 5 years. Five to 10% of patients with Torticollis
experience a spontaneous recovery, usually within 5 years after onset. This
recovery seems to be more common in those patients whose condition began
before 40 years of age and in those with a milder form. The disorder can
recur after apparent remission.
In some cases, the patient experiences pain which is generally focused on
one side and in one place. This varies from person to person, however. Pain
may occur on the side of the neck, in the back, or in the shoulder. One
shoulder may be higher than the other, and the arm or hand of the affected
side may occasionally have tremors or cramping. Spasmodic Torticollis is
often diminished or absent in the morning for a short time (10 minutes to 4
hours) upon awakening. Lying on their back provides relief for many
patients.
Causes
In most cases, the cause of Spasmodic Torticollis is unknown. However,
underlying psychological disturbances, basal ganglia (specific interconnected
gray masses deep in the cerebral hemispheres and in the upper brainstem)
disease, central nervous system infections, or tumors in the bones or soft
tissues of the neck may occasionally be implicated. Some people with
neuropsychiatric disorders may also have Spasmodic Torticollis, although they
are a small minority.
Affected Population
Onset of Spasmodic Torticollis is generally in the 4th or 5th decades of
life. It affects people of both sexes and all nationalities equally.
Related Disorders
Torsion Dystonia is an hereditary disorder which causes patients to develop
repetitive twisting and writhing involuntary movements including the muscles
in the neck. (For more information on this disorder, choose Torsion Dystonia
as your search term in the Rare Disease Database.)
Therapies: Standard
No treatment for Spasmodic Torticollis works for every patient. Medications
which are sometimes effective include:
Clonopin (clonazepam) and Valium (diazepam), anticonvulsants and muscle
relaxants
Artane (trihexyphenidyl) and Kemadrin (procyclidine hydrochloride),
anticholinergics
Lioresal (baclofen), a muscle relaxant
Tegretol (carbamazepine), an anticonvulsant and analgesic
Elavil (amitriptyline hydrochloride), an antidepressant
Symmetrel (amantadine hydrochloride), an antiviral compound
Miscellaneous: other drugs such as Reserpine, Parlodel, Sinemet, Triavil
and Lithium.
Physical therapy may be helpful in relieving spasm pain. Wearing a
cervical collar or orthopedic device to straighten the neck or reduce the
spasms is usually not effective.
Surgery is not usually beneficial, but it may sometimes be beneficial in
severe cases. Electrical nerve stimulation through the skin by TENS
(transcutaneous electrical nerve stimulation) may relieve pain. Pain control
may also sometimes be achieved by means of biofeedback, nerve blocks or
relaxation techniques.
Supportive counseling often helps the patient to understand and cope with
the disorder. An occupational therapist may be able to aid patients in
improving mobility and comfort.
The orphan drug botulinum A toxin was approved by the FDA for treatment
of patients with certain forms of dystonia, including Spasmodic Torticollis
and Torsion Dystonia. This drug is manufactured by Allergran
Pharmaceuticals, 2525 Dupont Dr., Irvine, CA, 92713.
Therapies: Investigational
The use of electronic spinal implants on people with Spasmodic Torticollis is
being studied with the hope of improving motor function in some individuals.
A double blind controlled study on 300 patients using an electronic orphan
device is being conducted by Neuromed, Inc., of Fort Lauderdale, Florida.
Patients wishing to participate in the FDA approved clinical trials should
contact:
Mr. William F. Jackson
Clinical Affairs Manager
Neuromed, Inc.
5000 Oakes Road
Ft. Lauderdale, FL 33314
800-327-9910
The NIH is giving botulinum injections to persons who qualify for the
program. To see if you qualify for this study, contact Suzanne at Dr. Mark
Hallet's office, National Institutes of Health, Bldg. 10, Rm. 5N22, 9000
Rockville Pike, Bethesda, MD, 20892, (301) 496-1561.
Porton Products Limited, 816 Connecticut Ave., NW, Washington, DC, 20006,
has received orphan product designation from the FDA for Clostridium
Botulinum Type F Neurotoxin, a treatment of Spasmodic Torticollis.
This disease entry is based upon medical information available through
December 1991. Since NORD's resources are limited, it is not possible to
keep every entry in the Rare Disease Database completely current and
accurate. Please check with the agencies listed in the Resources section for
the most current information about this disorder.
Resources
For more information on Spasmodic Torticollis, please contact:
National Organization for Rare Disorders (NORD)
P.O. Box 8923
New Fairfield, CT 06812-1783
(203) 746-6518
National Spasmodic Torticollis Association, Inc.
13545 Water Town Plank Rd.
P.O. Box 476
Elm Grove, WI 53122-0476
(800-HURTFUL) (487-8385)
Dystonia Medical Research Foundation
8383 Wilshire Blvd.
Beverly Hills, CA 90211
(213) 852-1630
Dystonia Medical Research
1 E. Wacker Dr., Suite 2900
Chicago, IL 60601-2098
NIH/National Institute of Neurological Disorders & Stroke (NINDS)
9000 Rockville Pike
Bethesda, MD 20892
(301) 496-5751
(800) 352-9424
International Tremor Foundation
360 W. Superior St.
Chicago, IL 60610
(312) 664-2344
References
THE MERCK MANUAL 15th ed: R. Berkow, et al: eds; Merck, Sharp & Dohme
Research Laboratories, 1987. P. 1290.
CECIL TEXTBOOK OF MEDICINE, 18th ed.: James B. Wyngaarden, and Lloyd H.
Smith, Jr., Eds.: W.B. Saunders Co., 1988. P. 2150.