Treatment of spastic torticollis abroad

Causes of development of torticollis in adults

There are several reasons for the development of torticollis in adults. However, it is not always possible to establish the specific cause of the pathology.

Typical causes of torticollis include:

• Injury to the neck or spine causing muscle spasm;
• Infection of the head or neck, in which the muscles contract due to inflammation;
• abscesses in the throat or upper respiratory tract;
• Infections of other organs and parts of the body, including the ears, sinuses, jaws, teeth, and scalp.

Less common causes of torticollis include:

• Scar tissue;
• Arthritis of the cervical spine;
• Vascular abnormalities;
• Loss of muscle control due to improper use of medications;
• Taking certain medications;
• Tumors.

Prescribed drugs

For the drug treatment of spastic torticollis, the following can be used:

• Muscle relaxants (baclofen);
• anticolvulsants with a muscle relaxant effect (clonazepam);
• anticholineptics;
• antidepressants;
• carbamazepine (finlepsin).

The most effective is the use of the nerve impulse blocker butoloxin, one injection of which lasts for 4-6 months.

Periodically, as prescribed by a doctor, it is necessary to take repeated courses of medications. The effects of the medications usually last for several weeks or months. Then the patient’s condition must be corrected again in order to avoid deterioration of well-being and possible complications.

Drug treatment of spasmodic torticollis can continue throughout the patient's life. To consolidate the results for a longer time after a course of medications, manual therapy, massage, and exercise therapy are used.

Development of torticollis in children

Children of any age, including infants, are often diagnosed with congenital muscular torticollis . This means that the pathology is already present at the birth of the child.

Congenital muscular torticollis indicates that the sternocleidomastoid muscle on one side of the neck is too short. Other causes of torticollis in children include:

• Birth injury;
• Flat head syndrome, diagnosed when a small child's head is always in the same position during sleep;
• Congenital diseases affecting the muscles and nervous system.

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What types of torticollis are treated at Assuta?

There are several types of torticollis, including the following:

• Temporary torticollis . Temporary torticollis usually bothers a person for only 1-2 days, after which it goes away. People with temporary torticollis need to keep their neck still while resting. Medical intervention in such cases is usually not required. Temporary torticollis develops when the lymph nodes become inflamed after a cold or infection, or when the joints in the cervical spine become swollen. Joints usually become swollen as a result of injury.
• Persistent torticollis . Persistent torticollis indicates a disorder in the structure of the musculoskeletal system. This pathology is also observed in spinal cord tumors that press on surrounding nerves. Persistent torticollis in children leads to flattening and other facial defects. Some children experience a delay in developing the ability to use their facial muscles correctly.
• Muscular torticollis . Muscular torticollis is the most common form of persistent torticollis. This is a consequence of either excessive tension in the muscles on one side of the neck, or the influence of scar tissue on its mobility. The pathological process can begin during intrauterine development. This occurs if the fetus does not have enough space or if it occupies an unusual position in the uterus.
• Klippel-Feil syndrome . Klippel-Feil syndrome is a congenital disorder. It is diagnosed when the curvature of the neck is caused by abnormal bone growth. Some people with Klippel-Feil syndrome also have hearing problems due to damage to the bones in the ears.
• Cervical dystonia . Cervical dystonia, or spasmodic torticollis, is one of the rarest forms of torticollis. Cervical dystonia causes spasms in the neck muscles. People with cervical dystonia experience painful attacks of contraction of the neck muscles. During such attacks, the head tilts to the side, forward or backward.

Disease - spastic torticollis

Spasmodic torticollis is a forced incorrect position of the head and neck associated with neurological changes in the transmission of impulses through muscle tissue. Deformation of these parts of the body can be congenital or acquired. In both cases, the main cause is chronic tension in the neck muscles. This disease, although not life-threatening, at the same time greatly reduces its quality.

At risk are:

• children who were born through caesarean section;
• persons with spinal injury;
• patients with a dislocated cervical vertebra;
• newborns with prenatal and birth injuries.

Symptoms of pathology

Symptoms of torticollis depend on the individual characteristics of the body. The most obvious sign of pathology is a crooked neck or head tilted to one side. Patients with torticollis also experience:

• Soreness, tension in the neck muscles;
• Muscle spasms or burning sensation in the neck;
• Reluctance to turn or tilt the head and neck in the opposite direction;
• A phenomenon in which the gaze is involuntarily directed upward;
• Spontaneous prolapse of the tongue;
• Sudden muscle contractions and movements of the head and neck;
• Backache;
• Headache.

Children under one year of age experience:

• Tilt of head to one side;
• Flattening of one side of the head (behind the ear);
• Limited range of movement of the head and neck;
• Asymmetrical facial features;
• Small, soft lump in the neck;
• Preference for one breast over the other when breastfeeding;
• Musculoskeletal disorders, including hip dysplasia.

With acquired rather than congenital torticollis, the child looks tired and irritable. Vomiting may occur when the head is tilted.

Diagnosis of torticollis at the Assuta clinic

Torticollis is diagnosed based on a physical examination and medical history . Additionally, the Assuta doctor clarifies what medications the patient is currently taking. An x-ray of the neck may be needed to check whether the pathology is caused by a fracture or bone displacement.

A computed tomography (CT) scan is ordered if the doctor suspects that torticollis has developed due to a difficult-to-diagnose disease or disorder, such as degenerative arthritis of the spine. In some situations, one may suspect that torticollis indicates the presence of a more severe pathology. If you experience any of the following symptoms, seek emergency medical attention. Potential dangers may include:

• Muscle spasms in the neck that appear after an injury;
• Difficulty swallowing;
• Breathing disorders;
• Difficulty walking;
• Speech disorders;
• Weakness or numbness in the arms and legs;
• Urinary disorders;
• Urinary or fecal incontinence;
• swelling of the mouth or tongue;
• Increased body temperature;
• Swelling of the lymph nodes;
• Headache.

Treatment methods for torticollis in Israel

Treatment for torticollis depends on its type and underlying cause. Sometimes the pathology goes away on its own after several days of rest with minimal strain on the neck. Treatment options for torticollis include:

• Ice compresses;
• Drug therapy;
• Devices that allow you to hold your neck in a fixed position;
• Physical therapy;
• Massage therapy;
• Stretching exercises;
• Surgical intervention.

If spasmodic torticollis is caused by injury or a side effect of medications, your doctor may prescribe muscle relaxants or anti-inflammatory drugs.

For chronic muscle spasms and cervical dystonia, botulinum toxin type A, or Botox, is used. It prevents muscles from contracting and thereby alleviates the condition of patients. In addition, Botox prevents the pathology from worsening. Surgery prevents new symptoms from occurring. Surgery is prescribed if other treatment methods do not produce the desired results. To prevent spasms, the surgeon cuts certain nerves and muscles.

Surgery is indicated for approximately 10% of children with congenital torticollis . During the procedure, the surgeon lengthens the sternocleidomastoid muscle in the neck. Such operations are usually carried out when the child reaches preschool age.

Brain stimulation is rarely used as a treatment for torticollis . During surgery, the doctor inserts a surgical wire into the part of the brain that controls movement. The wire interrupts signals from the brain to other organs and tissues. This treatment helps some patients with cervical dystonia.

If you have torticollis, you can also try some ways to treat pain and discomfort at home. Ways to relieve pain and discomfort from torticollis at home:

• Adequate sleep and rest. Symptoms of torticollis often disappear during sleep. The more you lie down and rest, the sooner you will feel better.
• Hot and cold compresses. Compresses relieve pain and relieve muscle tension.
• Touching the opposite side of the face, chin or neck. Such manipulations deceive the body and temporarily stop spasms.
• Fighting stress. Stress causes muscle tension and worsens the symptoms of torticollis. Knowing why you're stressed and using appropriate stress management techniques can help relieve the symptoms of torticollis.
• Stretching exercises. Try, for example, gradually tilting your head in the opposite direction, reaching further and further each time. This exercise increases your range of motion and relieves discomfort.

Before you begin neck stretching exercises, consult with an Assuta physical therapy specialist.

Stretching even helps newborns with torticollis. Try to have your baby turn his head in both directions to ease tension and help strengthen his neck muscles. Various stimuli can be used for this purpose, including sounds and light. The physical therapy specialist at Assuta Relax provides more intensive treatments. If necessary, he will tell you how to do stretching exercises at home, and you can help your child yourself.

Treatment

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Treatment of spastic torticollis is quite difficult , since most medications have a short or minimal therapeutic effect. Nevertheless, conservative methods can be effective; as they are exhausted, one should proceed to surgical intervention.

Drugs

This approach involves the gradual use of non-operative treatment methods, first of all the doctor prescribes medications.

Drug treatment includes the following medications::

• muscle relaxant Baclofen;
• anticonvulsant Clonazepam;
• Carbamazepine (Finlepsin);
• anticholinergics (drugs like Norakin, Akineton, Cyclodol); antidepressants.

Botulinum toxin (Botox, Dysport) shows higher effectiveness.

Botulinum toxin administered intramuscularly has a blocking effect on the transmission of neuromuscular impulses for some time. When administered correctly, the effect of the medication lasts for 4-6 months; after this period, repeated administration of the medication is indicated; therapy lasts for years.

Video: “Treatment of spasmodic torticollis with botulinum toxin”

Surgical treatment options

If the conservative approach is ineffective, surgical intervention is recommended.

The classic surgical method for treating torticollis is the intersection of the sternocleidomastoid muscle. The classic method of intersection of the sternocleidomastoid muscle of the neck or the nerve that innervates it has recently been practically not used due to the high risk of complications (impaired blood supply, sensitivity, muscle paralysis).

In modern medicine, innovative stereotactic operations are most often used; their implementation helps to relieve muscle spasms of the neck by influencing the extrapyramidal system.

The essence of the operation is to pass electrodes through small holes in the skull to the structures of the extrapyramidal system of the brain. As a result of applying a current of 130-150 Hz to the brain, the symptoms of cervical dystonia disappear; the technique also prevents the occurrence of pathological nerve impulses.

Stereotactic surgeries provide effective treatment of the disease , they have no complications, they have a short recovery period, and are suitable for treating patients of different ages. The method of implanting electrodes is considered safer and more effective; today, extensive experience has been accumulated in the use of such operations.

Folk recipes

In addition to drug treatment and surgical intervention, folk recipes are often used. The main method of treating the disease is to attach small weights to the shoulder on the affected side . The method is quite safe and effective; its use leads to consistent stretching and relaxation of the neck muscles, relieving spasms.

Small bags made of soft fabric filled with cereals, sand or any other similar material can be used as cargo. When treating a child, the bag can be sewn to clothing in any convenient place (in the armpit area) so that it does not interfere with movements.

Traditional recipes are also in demand; as a result of their use, muscles relax and the nervous system calms down.

Folk recipes:

1. Mix 100 g of lilac buds with 0.5 kg of pork fat, boil in a water bath for 1 hour, use the cooled mixture for rubbing 4 rubles. per day. Dissolve 0.2 g mummy in 1 tbsp. water, add 1 tsp. honey, drink 1 r. per day, in the morning half an hour before meals or before bed. The duration of the course is 3-4 minutes, the first improvements will appear in a few months.
2. Mix 75 g of linden flowers, 100 g of viburnum bark and 100 g of lavender, 2 tbsp. l of the mixture, pour 0.5 liters of water, bring the mixture to a boil for several minutes over low heat, leave for a while. 2 hours. Take the strained mixture 4 times. 100 ml per day half an hour before meals.

Recovery prognosis

Torticollis cannot always be prevented on its own, but with timely medical intervention it is possible to both prevent the appearance of new symptoms and completely eliminate the pathology. There are many ways to combat the symptoms of torticollis. Some remedies alleviate the signs of the disorder, while others make it possible to make manifestations of torticollis occur much less frequently. The prognosis for torticollis is generally considered favorable.

Torticollis can lead to disability , especially if the disorder is left unattended. People find it difficult to perform everyday tasks (such as driving a car). Many complain of persistent pain and discomfort.

Early medical intervention and physical therapy are the cornerstones of successful treatment of torticollis in infants and older children. Timely initiation of treatment can prevent the worsening of torticollis. In more severe cases, patients undergo surgery on the nerves and muscles of the neck . However, even though the patient has undergone surgery, torticollis can recur. Assuta doctors claim that in most cases, properly prescribed treatment can get rid of torticollis in a few days or weeks.

Spasmodic torticollis - treatment with the Ulzibat surgical method

The purpose of the operation is to cut the bases of the affected muscle with a specially designed scalpel, which does not leave behind incisions or scars. Unlike classical surgical techniques, staged fibrotomy is performed only on damaged areas of the muscle, without affecting the tendons; after the operation, the patient does not require casting, and care for postoperative wounds is simple and accessible. And what is important is that the operation has no contraindications associated with early age.

The surgical intervention is performed as quickly and safely as possible for both young patients and adults, and on average lasts no more than 20 minutes. The patient is released from the clinic on the same day and recovers in the comfort of home.

Treatment of torticollis in adult patients is carried out by surgery under local anesthesia, given its minimally invasive nature, and for children under 16 years of age under general anesthesia. Using this method of pain relief for children, we ensure a comfortable, painless operation and prevent the development of psychological trauma in the child.

For questions regarding the treatment of spastic torticollis, you can consult our surgeons by phone. You may need an in-person consultation before surgery. The doctor will not only assess the presence of deformity, but will also check muscle tone, conduct palpation and examination, and make an accurate diagnosis.

By contacting us, adults and the youngest patients have a unique opportunity to solve the problem quickly, effectively and with the least pain.