Spasmodic torticollis

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Spasmodic torticollis
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Muscles of the neck
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Spasmodic torticollis is an extremely painful chronic neurological movement disorder causing the neck to involuntarily turn to the left, right, upwards, and/or downwards. The condition is also referred to as "cervical dystonia". Both agonist and antagonist muscles contract simultaneously during dystonic movement. [1] Causes of the disorder are predominantly idiopathic. A small number of patients develop the disorder as a result of another disorder or disease. Most patients first experience symptoms midlife. The most common treatment for spasmodic torticollis is the use of botulinum toxin type A.

Contents

Signs and symptoms

Initial symptoms of spasmodic torticollis are usually mild. Some feel an invisible tremor of their head for a few months at onset. Then the head may turn, pull or tilt in jerky movements, or sustain a prolonged position involuntarily. Over time, the involuntary spasm of the neck muscles will increase in frequency and strength until it reaches a plateau. Symptoms can also worsen while the patient is walking or during periods of increased stress. Other symptoms include muscle hypertrophy, neck pain, dysarthria and tremor. [2] Studies have shown that over 75% of patients report neck pain, [1] and 33% to 40% experience tremor of the head. [3]

Pathophysiology

Coronal sections of human brain labeling the basal ganglia. Basal-ganglia-coronal-sections-large.png
Coronal sections of human brain labeling the basal ganglia.

The pathophysiology of spasmodic torticollis is still relatively unknown. Spasmodic torticollis is considered neurochemical in nature, and does not result in structural neurodegenerative changes. Although no lesions are present in the basal ganglia in primary spasmodic torticollis, fMRI and PET studies have shown abnormalities of the basal ganglia and hyper activation of the cortical areas. [4] Studies have suggested that there is a functional imbalance in the striatal control of the globus pallidus, specifically the substantia nigra pars reticulata. The studies hypothesize the hyper activation of the cortical areas is due to reduced pallidal inhibition of the thalamus, leading to over activity of the medial and prefrontal cortical areas and under activity of the primary motor cortex during movement. [5] It has also been suggested that the functional imbalance is due to an imbalance of neurotransmitters such as dopamine, acetylcholine, and gamma-aminobutyric acid. These neurotransmitters are secreted from the basal ganglia, traveling to muscle groups in the neck. An increase in neurotransmitters causes spasms to occur in the neck, resulting in spasmodic torticollis. [6] Studies of local field potentials have also shown an increase of 4–10 Hz oscillatory activity in the globus pallidus internus during myoclonic episodes and an increase of 5–7 Hz activity in dystonic muscles when compared to other primary dystonias. This indicates that oscillatory activity in these frequency bands may be involved in the pathophysiology of spasmodic torticollis. [7]

Diagnosis

The most commonly used scale to rate the severity of spasmodic torticollis is the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). It has been shown that this rating system has widespread acceptance for use in clinical trials, and has been shown to have “good interobserver reliability.” [8] There are three scales in the TWSTRS: torticollis severity scale, disability scale, and pain scale. These scales are used to represent the severity, the pain, and the general lifestyle of spasmodic torticollis.[ citation needed ]

Classification

Spasmodic torticollis is a form of focal dystonia, a neuromuscular disorder that consists of sustained muscle contractions causing repetitive and twisting movements and abnormal postures in a single body region. [9] There are two main ways to categorize spasmodic torticollis: age of onset, and cause. The disorder is categorized as early onset if the patient is diagnosed before the age of 27, and late onset thereafter. The causes are categorized as either primary (idiopathic) or secondary (symptomatic). Spasmodic torticollis can be further categorized by the direction and rotation of head movement.[ citation needed ]

Primary

Primary spasmodic torticollis is defined as having no other abnormality other than dystonic movement and occasional tremor in the neck. [1] This type of spasmodic torticollis is usually inherited. Studies have shown that the DYT7 locus on chromosome 18p in a German family and the DYT13 locus on chromosome 1p36 in an Italian family is associated with spasmodic torticollis. The inheritance for both loci is autosomal dominant. These loci are all autosomal dominantly inherited with reduced penetrance. Although these loci have been found, it is still not clear the extent of influence the loci have on spasmodic torticollis. [6]

Secondary

When other conditions lead to spasmodic torticollis, it is said that the spasmodic torticollis is secondary. A variety of conditions can cause brain injury, from external factors to diseases. These conditions are listed below: [1]

Secondary spasmodic torticollis is diagnosed when any of the following are present: history of exogenous insult or exposure, neurological abnormalities other than dystonia, abnormalities on brain imaging, particularly in the basal ganglia. [1]

Head positions

To further classify spasmodic torticollis, one can note the position of the head.

  • Torticollis is the horizontal turning (rotational collis) of the head, and uses the ipsilateral splenius, and contralateral sternocleidomastoid muscles. This is the "chin-to-shoulder" version.
  • Laterocollis is the tilting of the head from side to side. This is the "ear-to-shoulder" version. This involves many more muscles: ipsilateral sternocleidomastoid, ipsilateral splenius, ipsilateral scalene complex, ipsilateral levator scapulae, and ipsilateral posterior paravertebrals.
  • The flexion of the neck (head tilts forwards) is anterocollis. This is the "chin-to-chest" version and is the most difficult version to address. This movement utilizes the bilateral sternocleidomastoid, bilateral scalene complex, bilateral submental complex.
  • Retrocollis is the extension of the neck (head tilts back) and uses the following muscles for movement: bilateral splenius, bilateral upper trapezius, bilateral deep posterior paravertebrals. This is the "chin-in-the-air" version.

A combination of these head positions is common; many patients experience turning and tilting actions of the head. [10]

Treatment

There are several treatments for spasmodic torticollis, the most commonly used being botulinum toxin injections in the dystonic muscle of the neck. Other treatments include sensory trick for a mild occasional twinge, oral medications, and deep brain stimulation. Combinations of these treatments have been used to control spasmodic torticollis. [7] In addition, selective surgical denervation of nerves triggering muscle contractions may offer relief from spasms and pain, and limit damage to the spine as a result of torqued posture. Spinal fibrosis (i.e., locking of spinal facets due to muscular contortion resulting in fused vertebrae) may occur rapidly.

This suggests that the desynchronization of the frequency range is movement related. [5] Obtaining relief via a "sensory trick", also known as a geste antagoniste, is a common characteristic present in focal dystonias, most prevalently in cervical dystonia; however, it has also been seen in patients with blepharospasm. [11] Sensory tricks offer only temporary and often partial relief of spasmodic torticollis. 74% of patients report only partial relief of spasmodic torticollis compared to 26% reporting complete relief. The sensory trick must also be applied by the patient themselves. When the sensory trick is applied by an examiner, only 32% of patients report relief comparable to relief during self-application. [7] Since the root of the problem is neurological, doctors have explored sensorimotor retraining activities to enable the brain to "rewire" itself and eliminate dystonic movements. [12] [13] [14] [15]

Oral medications

In the past, dopamine blocking agents have been used in the treatment of spasmodic torticollis. Treatment was based on the theory that there is an imbalance of the neurotransmitter dopamine in the basal ganglia. These drugs have fallen out of fashion due to various serious side effects: sedation, parkinsonism, and tardive dyskinesia. [16] Other oral medications can be used in low doses to treat early stages of spasmodic torticollis. Relief from spasmodic torticollis is higher in those patients who take anticholinergic agents when compared to other oral medications. Many have reported complete management with gabapentin alone or in combination with another drug such as clonazepam.[ citation needed ] 50% of patients who use anticholinergic agents report relief, 21% of patients report relief from clonazepam, 11% of patients report relief from baclofen, and 13% from other benzodiazepines. [17]

Higher doses of these medications can be used for later stages of spasmodic torticollis; however, the frequency and severity of side effects associated with the medications are usually not tolerated. Side effects include dry mouth, cognitive disturbance, drowsiness, diplopia, glaucoma and urinary retention. [18]

Botulinum toxin

Target molecules of botulinum (BoNT) and tetanus (TeNT) toxins inside the axon terminal. Presynaptic CNTs targets.svg
Target molecules of botulinum (BoNT) and tetanus (TeNT) toxins inside the axon terminal.

The most commonly used treatment for spasmodic torticollis is the use of botulinum toxin injection in the dystonic musculature. Botulinum toxin type A is most often used; it prevents the release of acetylcholine from the presynaptic axon of the motor end plate, paralyzing the dystonic muscle. [16] By disabling the movement of the antagonist muscle, the agonist muscle is allowed to move freely. With botulinum toxin injections, patients experience relief from spasmodic torticollis for approximately 12 to 16 weeks. [19] There are several type A preparations available worldwide and in the United States. [20]

Some patients experience or develop immunoresistance to botulinum toxin type A and must use botulinum toxin type B. Approximately 4% to 17% of patients develop botulinum toxin type A antibodies. The only botulinum toxin type B accessible in the United States is Myobloc. Treatment using botulinum toxin type B is comparable to type A, with an increased frequency of the side effect dry mouth. [10] [21]

Common side effects include pain at the injection site (up to 28%), dysphagia due to the spread to adjacent muscles (11% to 40%), dry mouth (up to 33%), fatigue (up to 17%), and weakness of the injected or adjacent muscle (up to 56%). [16] A Cochrane review published in 2016 reported moderate-quality evidence that a single Botulinum toxin-B treatment session could improve cervical dystonia symptoms by 10% to 20%, although with an increased risk of dry mouth and swallowing difficulties. [22] Another Cochrane review published in 2020 for Botulinum toxin-A found similar results. [23]

Deep brain stimulation

Insertion of electrode during surgery Parkinson surgery.jpg
Insertion of electrode during surgery

Deep brain stimulation to the basal ganglia and thalamus has recently been used as a successful treatment for tremors of patients with Parkinson's disease. This technique is currently, as of 2007, being trialed in patients with spasmodic torticollis. Patients are subjected to stimulation of the globus pallidus internus, or the subthalamic nucleus. The device is analogous to a pacemaker: an external battery is placed subcutaneously, with wires under the skin which enter the skull and a region of the brain. To stimulate the globus pallidus internus, microelectrodes are placed into the globus pallidus internus bilaterally. After the surgery is performed, multiple visits are required to program the settings for the stimulator. The stimulation of the globus pallidus internus disrupts the abnormal discharge pattern in the globus pallidus internus, resulting in inhibition of hyperactive cortical activity. Globus pallidus internus deep brain stimulation is the preferred surgical procedure, due to the lower frequency of side effects. [16] Advantages of deep brain stimulation include the reversibility of the procedure, and the ability to adjust the settings of the stimulation. [17]

In one study, patients who had developed immunoresistance to botulinum toxin underwent globus pallidus internus deep brain stimulation, showing improvement by 54.4% after three to six months.[ citation needed ]

There is a low rate of side effects for those who undergo deep brain stimulation. The most common side effect is headache, occurring in 15% of patients, followed by infection (4.4%) and cognitive dysfunction (4%). Serious side effects are seizure (1.2%), intracerebral hemorrhage (0.6%), intraventricular hemorrhage (0.6%), and large subdural hematoma (0.3%). [16]

Physical Interventions

Physical treatment options for cervical dystonia include biofeedback, mechanical braces as well as patients self-performing a geste antagoniste. Physical therapy also has an important role in managing spasmodic torticollis by providing stretching and strengthening exercises to aid the patient in keeping their head in proper alignment with their body. [19] Patients with cervical dystonia ranked physical therapy intervention second to botulinum toxin injections in overall effectiveness in reducing symptoms [24] and patients receiving physiotherapy in conjunction with botulinum toxin injections reported enhanced effects of treatment compared to the injections alone. [25] One study examined patients with cervical dystonia who were treated with a physiotherapy program that included muscle stretching and relaxation, balance and coordination training, and exercises for muscle strengthening and endurance. A significant reduction in pain and severity of dystonia as well as increased postural awareness and quality of life was found. [26]

Epidemiology

Spasmodic torticollis is one of the most common forms of dystonia seen in neurology clinics, occurring in approximately 0.390% of the United States population in 2007 (390 per 100,000). [3] Worldwide, it has been reported that the incidence rate of spasmodic torticollis is at least 1.2 per 100,000 person years, [27] and a prevalence rate of 57 per 1 million. [28] The exact prevalence of the disorder is not known; several family and population studies show that as many as 25% of cervical dystonia patients have relatives that are undiagnosed. [29] [30] Studies have shown that spasmodic torticollis is not diagnosed immediately; many patients are diagnosed well after a year of seeking medical attention. [1] A survey of 59 patients diagnosed with spasmodic torticollis show that 43% of the patients visited at least four physicians before the diagnosis was made. [31]

There is a higher prevalence of spasmodic torticollis in females; females are 1.5 times more likely to develop spasmodic torticollis than males. The prevalence rate of spasmodic torticollis also increases with age, most patients show symptoms from ages 50–69. The average onset age of spasmodic torticollis is 41. [1]

Related Research Articles

<span class="mw-page-title-main">Torticollis</span> Medical condition

Torticollis, also known as wry neck, is a painful, dystonic condition defined by an abnormal, asymmetrical head or neck position, which may be due to a variety of causes. The term torticollis is derived from the Latin words tortus, meaning "twisted", and collum, meaning "neck".

<span class="mw-page-title-main">Deep brain stimulation</span> Neurosurgical treatment involving implantation of a brain pacemaker

Deep brain stimulation (DBS) is a surgical procedure that implants a neurostimulator and electrodes which sends electrical impulses to specified targets in the brain responsible for movement control. The treatment is designed for a range of movement disorders such as Parkinson's disease, essential tremor, and dystonia, as well as for certain neuropsychiatric conditions like obsessive-compulsive disorder (OCD) and epilepsy. The exact mechanisms of DBS are complex and not entirely clear, but it is known to modify brain activity in a structured way.

A wrinkle, also known as a rhytid, is a fold, ridge or crease in an otherwise smooth surface, such as on skin or fabric. Skin wrinkles typically appear as a result of ageing processes such as glycation, habitual sleeping positions, loss of body mass, sun damage, or temporarily, as the result of prolonged immersion in water. Age wrinkling in the skin is promoted by habitual facial expressions, aging, sun damage, smoking, poor hydration, and various other factors. In humans, it can also be prevented to some degree by avoiding excessive solar exposure and through diet.

<span class="mw-page-title-main">Dystonia</span> Neurological movement disorder

Dystonia is a neurological hyperkinetic movement disorder in which sustained or repetitive muscle contractions result in twisting and repetitive movements or abnormal fixed postures. The movements may resemble a tremor. Dystonia is often intensified or exacerbated by physical activity, and symptoms may progress into adjacent muscles.

<span class="mw-page-title-main">Hyperkinesia</span> Excessive movements due to basal ganglia dysfunction

Hyperkinesia refers to an increase in muscular activity that can result in excessive abnormal movements, excessive normal movements, or a combination of both. Hyperkinesia is a state of excessive restlessness which is featured in a large variety of disorders that affect the ability to control motor movement, such as Huntington's disease. It is the opposite of hypokinesia, which refers to decreased bodily movement, as commonly manifested in Parkinson's disease.

Focal dystonia, also called focal task-specific dystonia, is a neurological condition that affects a muscle or group of muscles in a specific part of the body during specific activities, causing involuntary muscular contractions and abnormal postures. There are many different types of focal dystonia, each affecting a different region of the body. For example, in focal hand dystonia, or writer's cramp, the fingers either curl into the palm or extend outward without control. In musicians, the condition is called musician's focal dystonia, or simply, musician's dystonia. In sports, it may be involved in what is commonly referred to as the yips. The condition appears to be associated with over-training, and individualized treatment strategies may involve medications, retraining techniques, and procedures.

Torsion dystonia, also known as dystonia musculorum deformans, is a disease characterized by painful muscle contractions resulting in uncontrollable distortions. This specific type of dystonia is frequently found in children, with symptoms starting around the ages of 11 or 12. It commonly begins with contractions in one general area such as an arm or a leg that continue to progress throughout the rest of the body. It takes roughly 5 years for the symptoms to completely progress to a debilitating state.

Hemiballismus or hemiballism is a basal ganglia syndrome resulting from damage to the subthalamic nucleus in the basal ganglia. Hemiballismus is a rare hyperkinetic movement disorder, that is characterized by violent involuntary limb movements, on one side of the body, and can cause significant disability. Ballismus affects both sides of the body and is much rarer. Symptoms can decrease during sleep.

Hypokinesia is one of the classifications of movement disorders, and refers to decreased bodily movement. Hypokinesia is characterized by a partial or complete loss of muscle movement due to a disruption in the basal ganglia. Hypokinesia is a symptom of Parkinson's disease shown as muscle rigidity and an inability to produce movement. It is also associated with mental health disorders and prolonged inactivity due to illness, amongst other diseases.

<span class="mw-page-title-main">Blepharospasm</span> Abnormal contraction or twitch of the eyelid

Blepharospasm is any abnormal contraction of the orbicularis oculi muscle. The condition should be distinguished from the more common, and milder, involuntary quivering of an eyelid, known as myokymia, or fasciculation. In most cases, blepharospasm symptoms last for a few days and then disappear without treatment, but in some cases the twitching is chronic and persistent, causing life-long challenges. In these cases, the symptoms are often severe enough to result in functional blindness. The person's eyelids feel like they are clamping shut and will not open without great effort. People have normal eyes, but for periods of time are effectively blind due to their inability to open their eyelids. In contrast, the reflex blepharospasm is due to any pain in and around the eye.

<span class="mw-page-title-main">Meige's syndrome</span> Medical condition

Meige's syndrome is a type of dystonia. It is also known as Brueghel's syndrome and oral facial dystonia. It is actually a combination of two forms of dystonia, blepharospasm and oromandibular dystonia (OMD).

<span class="mw-page-title-main">Pallidotomy</span> Surgical procedure to damage the globus pallidus

Pallidotomy is a neurosurgical procedure. It is used to treat Parkinson's disease and some other conditions, often as an alternative to deep brain stimulation. It involves placing a tiny electrical probe in the globus pallidus, one of the basal ganglia of the brain, to damage it. Unilateral pallidotomy can cause side effects including problems with language learning, visuospatial constructional ability, and executive functions. Bilateral pallidotomy is not effective, with many severe side effects.

Spasmodic dysphonia, also known as laryngeal dystonia, is a disorder in which the muscles that generate a person's voice go into periods of spasm. This results in breaks or interruptions in the voice, often every few sentences, which can make a person difficult to understand. The person's voice may also sound strained or they may be nearly unable to speak. Onset is often gradual and the condition is lifelong.

<span class="mw-page-title-main">External globus pallidus</span> Part of the globus pallidus

The external globus pallidus combines with the internal globus pallidus (GPi) to form the globus pallidus, an anatomical subset of the basal ganglia. Globus pallidus means "pale globe" in Latin, indicating its appearance. The external globus pallidus is the segment of the globus pallidus that is relatively further (lateral) from the midline of the brain.

<span class="mw-page-title-main">Internal globus pallidus</span>

The internal globus pallidus and the external globus pallidus (GPe) make up the globus pallidus. The GPi is one of the output nuclei of the basal ganglia. The GABAergic neurons of the GPi send their axons to the ventral anterior nucleus (VA) and the ventral lateral nucleus (VL) in the dorsal thalamus, to the centromedian complex, and to the pedunculopontine complex.

Myoclonic dystonia or Myoclonus dystonia syndrome is a rare movement disorder that induces spontaneous muscle contraction causing abnormal posture. The prevalence of myoclonus dystonia has not been reported, however, this disorder falls under the umbrella of movement disorders which affect thousands worldwide. Myoclonus dystonia results from mutations in the SGCE gene coding for an integral membrane protein found in both neurons and muscle fibers. Those suffering from this disease exhibit symptoms of rapid, jerky movements of the upper limbs (myoclonus), as well as distortion of the body's orientation due to simultaneous activation of agonist and antagonist muscles (dystonia).

<span class="mw-page-title-main">Basal ganglia disease</span> Group of physical problems resulting from basal ganglia dysfunction

Basal ganglia disease is a group of physical problems that occur when the group of nuclei in the brain known as the basal ganglia fail to properly suppress unwanted movements or to properly prime upper motor neuron circuits to initiate motor function. Research indicates that increased output of the basal ganglia inhibits thalamocortical projection neurons. Proper activation or deactivation of these neurons is an integral component for proper movement. If something causes too much basal ganglia output, then the ventral anterior (VA) and ventral lateral (VL) thalamocortical projection neurons become too inhibited, and one cannot initiate voluntary movement. These disorders are known as hypokinetic disorders. However, a disorder leading to abnormally low output of the basal ganglia leads to reduced inhibition, and thus excitation, of the thalamocortical projection neurons which synapse onto the cortex. This situation leads to an inability to suppress unwanted movements. These disorders are known as hyperkinetic disorders.

<span class="mw-page-title-main">Camptocormia</span> Symptom of a multitude of diseases, most commonly seen in the elderly

Camptocormia, also known as bent spine syndrome (BSS), is a symptom of a multitude of diseases that is most commonly seen in the elderly. It is identified by an abnormal thoracolumbar spinal flexion, which is a forward bending of the lower joints of the spine, occurring in a standing position. In order to be classified as BSS, the anterior flexion must be of 45 degrees anteriorly. This classification differentiates it from a similar syndrome known as kyphosis. Although camptocormia is a symptom of many diseases, there are two common origins: neurological and muscular. Camptocormia is treated by alleviating the underlying condition causing it through therapeutic measures or lifestyle changes.

Dyskinetic cerebral palsy (DCP) is a subtype of cerebral palsy (CP) and is characterized by impaired muscle tone regulation, coordination and movement control. Dystonia and choreoathetosis are the two most dominant movement disorders in patients with DCP.

Alan Brown Scott was an American ophthalmologist specializing in eye muscles and their disorders, such as strabismus. He is best known for his work in developing and manufacturing the drug that became known as Botox, research described as "groundbreaking" by the ASCRS.

References

  1. 1 2 3 4 5 6 7 Geyer HL; Bressman SB. (2006). "The diagnosis of dystonia". The Lancet Neurology. 5 (9): 780–790. doi:10.1016/S1474-4422(06)70547-6. PMID   16914406. S2CID   28374695.
  2. ↑ "Spasmodic Torticollis – Signs and Symptoms". NSTA. National Spasmodic Torticollis Association. Retrieved December 29, 2018.
  3. 1 2 Jankovic J; Tsui J; Bergeron C. (2007). "Prevalence of Cervical Dystonia and Spasmodic Torticollis in the United States general population". Parkinsonism and Related Disorders. 13 (7): 411–6. doi:10.1016/j.parkreldis.2007.02.005. PMID   17442609.
  4. ↑ Vacherot F, Vaugoyeau M, Mallau S, Soulayrol S, Assaiante C, Azulay JP (May 2007). "Postural control and sensory integration in cervical dystonia". Clin Neurophysiol. 118 (5): 1019–27. doi:10.1016/j.clinph.2007.01.013. PMID   17383228. S2CID   45602523.
  5. 1 2 Uc EY; Rodnitzky RL. (2003). "Childhood Dystonia". Seminars in Pediatric Neurology. 10 (1): 52–61. doi:10.1016/S1071-9091(02)00010-4. PMID   12785748.
  6. 1 2 de Carvalho Aguiar PM, Ozelius LJ (September 2002). "Classification and genetics of dystonia". Lancet Neurol. 1 (5): 316–25. doi:10.1016/S1474-4422(02)00137-0. PMID   12849429. S2CID   29200547.
  7. 1 2 3 Tang JK, et al. (2007). "Changes in cortical and pallidal oscillatory activity during the execution of a sensory trick in patients with cervical dystonia". Experimental Neurology. 204 (2): 845–8. doi:10.1016/j.expneurol.2007.01.010. hdl: 1807/17904 . PMID   17307166. S2CID   3255050.
  8. ↑ Salvia P, Champagne O, Feipel V, Rooze M, de Beyl DZ (May 2006). "Clinical and goniometric evaluation of patients with spasmodic torticollis". Clin Biomech (Bristol, Avon). 21 (4): 323–9. doi:10.1016/j.clinbiomech.2005.11.011. PMID   16427167.
  9. ↑ Richter A, Löscher W (April 1998). "Pathology of idiopathic dystonia: findings from genetic animal models". Prog. Neurobiol. 54 (6): 633–77. doi:10.1016/S0301-0082(97)00089-0. PMID   9560845. S2CID   53173608.
  10. 1 2 Brashear A. (2004). "Treatment of cervical dystonia with botulinum toxin". Operative Techniques in Otolaryngology–Head and Neck Surgery. 15 (2): 122–7. doi:10.1016/j.otot.2004.03.004.
  11. ↑ Poisson, A.; Krack P.; Thobois S.; Loiraud C.; Serra G.; Vial C.; Broussolle E. (2012). "History of the "geste antagoniste" sign in cervical dystonia". Journal of Neurology. 259 (8): 1580–1584. doi:10.1007/s00415-011-6380-7. PMID   22234840. S2CID   27142003.
  12. ↑ "Dystonia. Rewiring the brain through movement and dance | Federico Bitti | TEDxNapoli" – via www.youtube.com.
  13. ↑ "How your movements can heal your brain | Joaquin Farias | TEDxNapoli" – via www.youtube.com.
  14. ↑ Farias J. Limitless. How your movements can heal your brain. An essay on the neurodynamics of dystonia. Galene editions 2016
  15. ↑ Farias J. Intertwined. How to induce neuroplasticity. A new approach to rehabilitate dystonias. Galene editions 2012.
  16. 1 2 3 4 5 Adam OR, Jankovic J (2007). "Treatment of dystonia". Parkinsonism Relat. Disord. 13 (Suppl 3): S362–8. doi:10.1016/S1353-8020(08)70031-2. PMID   18267265.
  17. 1 2 Crowner BE. (2007). "dystonia: disease profile and clinical management". Physical Therapy. 87 (11): 1511–26. doi: 10.2522/ptj.20060272 . PMID   17878433.
  18. ↑ Ochudlo S; Drzyzga K; Drzyzga LR; Opala G. (2007). "Various patterns of gestes antagonists in cervical dystonia". Parkinsonism and Related Disorders. 13 (7): 417–420. doi:10.1016/j.parkreldis.2007.01.004. PMID   17355914.
  19. 1 2 Velickovic M, Benabou R, Brin MF (2001). "Cervical dystonia pathophysiology and treatment options". Drugs. 61 (13): 1921–43. doi:10.2165/00003495-200161130-00004. PMID   11708764. S2CID   46954613.
  20. ↑ "Botulinum Neurotoxin Injections". Dystonia Medical Research Foundation. 2022-09-28. Retrieved 2022-09-28.
  21. ↑ Walker, Thomas J.; Dayan, Steven H. (2014-02-01). "Comparison and Overview of Currently Available Neurotoxins". The Journal of Clinical and Aesthetic Dermatology. 7 (2): 31–39. ISSN   1941-2789. PMC   3935649 . PMID   24587850.
  22. ↑ Marques, RE; Duarte, GS; Rodrigues, FB; Castelão, M; Ferreira, J; Sampaio, C; Moore, AP; Costa, J (13 May 2016). "Botulinum toxin type B for cervical dystonia". The Cochrane Database of Systematic Reviews. 2016 (5): CD004315. doi:10.1002/14651858.CD004315.pub3. PMC   8552447 . PMID   27176573.
  23. ↑ Rodrigues, Filipe B.; Duarte, Gonçalo S.; Marques, Raquel E.; Castelão, Mafalda; Ferreira, Joaquim; Sampaio, Cristina; Moore, Austen P.; Costa, João (November 12, 2020). "Botulinum toxin type A therapy for cervical dystonia". The Cochrane Database of Systematic Reviews. 2020 (11): CD003633. doi:10.1002/14651858.CD003633.pub4. ISSN   1469-493X. PMC   8106615 . PMID   33180963.
  24. ↑ Silfors, Anders; Göran Solders (2002). "Living with dystonia. A questionnaire among members of the Swedish Dystonia Patient Association". Läkartidningen. 99 (8): 786–789.
  25. ↑ Tassorelli C, Mancini F, Balloni L, Pacchetti C, Sandrini G, Nappi G, Martignoni E (December 2006). "Botulinum toxin and neuromotor rehabilitation: An integrated approach to idiopathic cervical dystonia". Mov. Disord. 21 (12): 2240–3. doi:10.1002/mds.21145. PMID   17029278. S2CID   16366190.
  26. ↑ Zetterberg L, Halvorsen K, Färnstrand C, Aquilonius SM, Lindmark B (2008). "Physiotherapy in cervical dystonia: six experimental single-case studies". Physiother Theory Pract. 24 (4): 275–90. doi:10.1080/09593980701884816. PMID   18574753. S2CID   20722262.
  27. ↑ Claypool DW, Duane DD, Ilstrup DM, Melton LJ (September 1995). "Epidemiology and outcome of cervical dystonia (spasmodic torticollis) in Rochester, Minnesota". Mov. Disord. 10 (5): 608–14. doi:10.1002/mds.870100513. PMID   8552113. S2CID   25177370.
  28. ↑ The Epidemiological Study of Dystonia in Europe (ESDE) Collaborative (2000). "A prevalence study of primary dystonia in eight European countries". Journal of Neurology. 247 (10): 787–92. doi:10.1007/s004150070094. PMID   11127535. S2CID   26041305.
  29. ↑ Waddy HM, Fletcher NA, Harding AE, Marsden CD (March 1991). "A genetic study of idiopathic focal dystonias". Ann. Neurol. 29 (3): 320–4. doi:10.1002/ana.410290315. PMID   2042948. S2CID   37961232.
  30. ↑ Duffey PO, Butler AG, Hawthorne MR, Barnes MP (1998). "The epidemiology of the primary dystonias in the north of England". Adv Neurol. 78: 121–5. PMID   9750909.
  31. ↑ van Herwaarden GM, Anten HW, Hoogduin CA, et al. (August 1994). "Idiopathic spasmodic torticollis: a survey of the clinical syndromes and patients' experiences". Clin Neurol Neurosurg. 96 (3): 222–5. doi:10.1016/0303-8467(94)90072-8. PMID   7988090. S2CID   27554275.
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