Close to deforming muscular dystonia is torticollis syndrome, the most characteristic manifestations of which are abnormal position of the head and a change in muscle tone of the neck. Torticollis can occur in many diseases – Goettington’s chorea , athetosis and parkinsonism. It can be the initial stage of development of deforming muscular dystonia. From these forms, a separate nosological form is distinguished – torticolis spastica , characterized by an isolated postural deviation of the head or irregular movements in the neck. As a rule, with torticolis spastica, involuntary movements are limited only to the muscles of the neck, only occasionally – spreading to the muscles of the face and platysm . The disease usually begins between the ages of 17 and 60, with a maximum occurring at the age of 30 to 40 years. Men get sick more often than women. The clinical manifestations of torticollis can vary significantly, even in the same patient. The most characteristic are long tonic contractions of the neck muscles. Since their voltage is not symmetrical, then there is an inclination or rotation of the head to the side, less often forward or backward. A certain position of the head can be maintained for a while, and then there is slight relaxation. Occasionally, fast, teaky movements such as myoclonus are possible . Arbitrary movements in the direction opposite to the direction of hyperkinesis, in many cases become impossible due to the strong simultaneous contraction of the antagonist muscles. It is characteristic that the patient can, with a little effort – touching a finger on the cheek – hold his head and thereby prevent it from turning or tipping over. Over time, from constant exercise, hypertrophy of the muscles that develops stress in the first place (m. Sternocleidomastoideus , less often w. Trapecius and deep neck muscles) develops . Emotions, fatigue enhance hyperkinesis, while rest and a calm state reduce them. In a horizontal position, hyperkinesis is less pronounced, and completely disappears during sleep. Reduction of hyperkinesis can be achieved if the patient stands near the wall and rests on the back of his head. It is possible that in the pathogenesis of spastic torticollis a certain role belongs to the vestibular system, which largely determines the correct position of the head. In rare cases, spastic torticollis may have a neurotic basis or be congenital in nature. Congenital torticollis due to shortening of m. sternocleidomastoideus or anomaly of the cervical vertebrae. In these cases, t. Sternocleidomastoideus stress is not observed. When conducting a differential diagnosis, one should also bear in mind Grisel’s disease – the analgesic contracture of the cervical muscles develops as a result of subluxation of the atlantooccipital joint due to the spread of the inflammatory process from the nasopharynx to the upper cervical vertebrae.
Treatment of deforming muscular dystonia
Some improvement in the condition of patients is noted with the appointment of anticholinergics , sedatives. The widespread use of 1-DOPA in the treatment of Parkinson’s syndrome has led to the use of this drug for deforming muscular dystonia and spastic torticollis. And, indeed, in some cases good results are observed. It should only be borne in mind that in children it is necessary to use small dosages and select them strictly individually. In the literature there are indications of a beneficial effect and drugs of the opposite effect, in particular – haloperidol . In cases that are not amenable to conservative therapy, one should resort to surgical methods of treatment-stereotactic operations on the subcortical ganglia. With spastic crankshaft, positive results can be obtained after the intersection of 3-4 pairs of the upper cervical roots and additional nerves.