Okay, so what can I do? I NEED RELIEF!

Treatment for cervical dystonia includes a range of options. These are specific medications, botulinum toxin A injections, surgery and conservative treatments. The variety of treatments are open for discussion. Your options need to be discussed thoroughly with your specialist doctor and your general practitioner, who can contact your specialist physician when required. Your specific needs may vary in comparison to needs of others. A case management plan, including treatment, needs to be the right one for you. (You can access information used in this article through www.asta.asn.au so do have a browse.)

· MEDICATION treatment, although helpful for only a small number of people with dystonia, includes anticholinergics, dopaminergics, antispasmodics and benzodiazepines. Pain relief medications may also provide relief. Speak to your doctor about whether you need to use pain control intermittently rather than regularly.

Benzodiazepines, muscle relaxants, such as diazepam (valium); clonazepam (rivotril) and lorazepam (ativan) may be helpful for some people with cervical dystonia by relieving symptoms of increased muscle activity. It is essential you discuss possible side effects of these medications with your doctor.

ANTISPASMODICS such as baclofen may be of benefit in tablet form for some people. Alternatively, delivery by a pump into a catheter placed within layers of the spinal cord coverings may offer significant relief from pain. Although effective in relieving spasms, this method may be complicated by muscle weakness and must be discussed thoroughly with your doctor.

DOPAMINERGICS, primarily prescribed for people with parkinson’s disease, are also useful for people suffering from dystonia. It is important to remember, cervical dystonia is NOT a form of parkinson’s disease. Levodopa offers relief predominantly for those diagnosed with dopa-responsive dystonia (Segawa’s disease) by replacing dopamine, one of the neurotransmitters. Now, last, but not least,

ANTICHOLINERGICS such as benzhexol (artane) has been successfully used by some people with cervical dystonia. This is another drug used for parkinson’s disease but found to be helpful also for treating symptoms of cervical dystonia. You need to carefully discuss this option with your doctor as there are known side effects that are most unpleasant for some people.

Remember, literature suggests medication therapy is successful in treating cervical dystonia only in a small percentage of people.

· BOTULINUM TOXIN (BOTOX) type A remains the most popular form of treatment and is considered by specialist physicians treating cervical dystonia to be the most effective form of treatment for this condition. In Australia, you will need to discuss with your specialist physician the relevant approval documents before receiving this treatment.

BOTOX is administered by injection into the muscles of the neck that are identified as being overactive and contributing to spasm, pain and abnormal posture.

ELECTROMYOGRAPHY (EMG) is used to assist with administering the injections. Recording the degree of muscle activity can be quite a noisy affair! However, following several successful applications of Botox therapy you may not need to have the electromyograph at the time of treatment.

TOXIN damages nerve supply to the affected muscles causing them to weaken. Thus, the person gains relief from spasms. Rather than discussing Botox more at this point, I will focus on a future article about this drug. However, I will point out, injected muscles will become overactive again over time and treatment will need to be repeated as often as is necessary to gain quality relief.

· SURGERY is one form of treatment not used widely in Australia. However, in North America a relatively recent procedure is proving to be significantly successful. People with uncomplicated cervical dystonia who have previously responded well to Botox therapy appear to gain most benefit from this form of intervention.

· CONSERVATIVE treatments are popular amongst some people with cervical dystonia. These treatments range across interventions such as physiotherapy, wheat pillows, regular exercise combined with a well balanced diet, homoeopathic remedies, vitamin therapy and, meditation and relaxation therapy, are all methods that work well for some people. All these options need to be discussed thoroughly with your doctors before deciding to include them with any of the above mentioned options discussed or using them as a primary source of treatment. Remember, consult, consult and then consult again with your medical team before settling on what is the best long term treatment for you.

I will follow up with a short article on suspected causes of cervical dystonia so do watch out for it. Meanwhile, don’t forget you are most welcome to leave a comment. Your comment can be entered as anonymous if you are not yet a member of blogspot.com or alternatively, you can register as a member. Receive lots of enjoyment through reading and replying to articles you are interested in. My email address is s.j.bayliss@bigpond.com.au, quite a few people have contacted me already in this way. To all those who have, I will get back to you within a day or two of receiving your emails. Well, I endeavor to anyway!

Sue Bayliss. Cairns, Australia.