My mom has cervical dystonia. Will physiotherapy help her?

Question

Hello doctor,

My mother, aged 61, has had involuntary neck twisting and stiffness for the past two years. Her MRI brain was normal, and the neurologist diagnosed cervical dystonia.

She has been taking Clonazepam and Baclofen, but the relief is only partial. So I would like to get your suggestion on the following -

Would Botulinum toxin injections be more effective, and how often do they need to be repeated?
Also, are there long-term side effects like muscle weakness from such injections?
Can physiotherapy or stress reduction help control the muscle spasms?
We also read about deep brain stimulation for severe cases, when it is considered necessary, and is it safe for older adults like her?

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

I understand that your mother has cervical dystonia and is on Clonazepam and Baclofen with partial relief. There are also other medications to try.

You can consult with your neurologist or start her on tablet Trihexiphenidyl 1 mg twice daily for a week and then escalate to 2 mg twice daily.

There are other options as well, including Sinemet, which she can try later on.

Botox (botulinum toxin) is also a great option, with results lasting six to nine months, thereafter requiring repeat injections. It works by relaxing the overactive injection, thereby letting the opposite muscle work and bring the neck to the neutral position.

Muscle weakness can occur in rare cases, but the incidence is low, and this effect persists as long as it remains in the system.

Physiotherapy and stress relief are not really treatment options because the spasticity comes from a pathology in the brain, so while the patient may feel relaxed, it does not help with the disease.

Deep brain stimulation is a great option if the patient is otherwise healthy. The initial phase of calibrating the system to achieve proper results may take some time, but once the correct settings are established, patients typically do very well with DBS.

I hope this helps.

Thank you and take care.

Regards.