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The
goals of treatment are to reduce the symptoms of Spasmodic Torticollis
(ST), while minimizing the risks of the interventions. There is little
consensus about the best management strategy. Three general categories
of treatment are available and include non-medical, medical and surgical.
Non-medical therapies include physiotherapy,
stress management and relaxation therapy, biofeedback and hypnosis.
These modalities are generally ineffective in reducing ST when applied
on their own, but may be complimentary to other treatment approaches.
Medical therapy involves the use of drugs
to relieve symptoms. Oral medications to treat ST include anticholinergics,
dopaminergics and benzodiazepines. A special type of medical therapy
consists of injecting botulinum toxin (BOTOX®) into the affected muscles.
BOTOX® often produces relief of symptoms for months at a time. Repeated
injections may provide long-term control of ST.
Neurosurgery is usually considered when
all other treatments have failed. Many types of surgery exist, but they
can be considered in two categories: (1) Destructive and (2) Non-Destructive.
Microvascular decompression (MVD) surgery is a non-destructive procedure
in which blood vessels that compress and irritate certain nerves are
moved without injury to the vessels or brain structures. Destructive
procedures aim to produce controlled injuries to the nerves and/or muscles.
These include thalamotomy, pallidotomy,
myotomy and selective peripheral denervation.
Decisions regarding the use of medications,
the timing of surgery and the specific surgical procedure may be complex.
These should be based upon a good understanding of all of the treatment
options. It is also important that the medical team has experience and
expertise in providing the treatments selected.
Continue to Medications.
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