HanoiThe 37-year-old man has a crooked neck, his head is always in an abnormal right and back rotation position, limited head and neck movement and very difficult walking.
He went to the Viet Duc Friendship Hospital to examine and was diagnosed with severe cervical dystonia with a 24/35 score.
Dystonia is a motor disorder of the nervous system, manifested by involuntary repeated or continuous muscle contraction, abnormal posture of one or many different areas of the body. The incidence of dystonia is about one in 2,000 people.
The best method of treatment is botulinum toxin A injection. Doctors inject the drug under the direction of an electromechanical machine (which increases accuracy). After a week, the patient had a 40% improvement in neck muscles, performing an easy personal activity.
Doctor Ngo Thi Huyen, Department of Neurosurgery Internal Medicine, Viet Duc Friendship Hospital, said dystonia can occur in any part of the body. There are many clinical forms of dystonia. For example, eyelid spasm, jaw dystonia, or spasm of the muscles in the jaw area causes a patient to speak his mouth with constriction or a natural jaw bite. Neck dystonia causes the patient’s neck to rotate / fold / tilt frequently to one side. Hand dystonia is when a patient writes / plays an instrument, the wrist or finger is folded, making the writing difficult, often misidentified as a joint disease or carpal tunnel syndrome. Pronunciation dystonia, the patient pronounces interrupted sounds difficult to hear. Someone has total dystonia.
Dystonia is caused by dysfunction of the gray nuclei in the brain. Medical conditions that can cause central graying include: inflammation of the nervous system, brain tumors, stroke, degenerative encephalopathy, genetic disease. Cases of unexplained dystonia are considered idiopathic (primary dystonia).
Doctors conduct tests to find the cause, treat the etiology to relieve symptoms and stop the disease process. In case the cause has been treated and the symptoms still do not go away, then treatment to relieve the patient’s symptoms, including oral medication, botulinum toxin injection, surgery and supportive treatment.
Dr Huyen said that oral medications reduced symptoms in about 10-30% of cases. Depending on the specific case, your doctor may choose anticholinergic drugs, baclofen, benzodiazepines (seduxen, rivotril), or levodopa, tetrabenazine. Or, a combination of these drugs for treatment, but the overall effect when using the drug is quite low.
Botulinum toxin injection is often used in patients with local dystonia. Effective in about 60-90% of cases depending on the type of dystonia, the effect lasts an average of 3-4 months per injection, or may be longer.
10-30% of patients do not respond to the above methods, severely disabled can surgery. There are many surgical methods such as muscle resection, nerve resection; nuclear burning surgery in the brain; deep brain stimulation electrode placement surgery; surgical placement of the drug baclofen pump. In which deep brain stimulation is the most used surgical method for dystonia, effective up to 60-80%.
In addition, the patient exercises physical therapy, rehabilitation exercises, pain treatment, psychosocial support and genetic counseling. Other methods of treatment, such as oriental medicine, acupuncture, and massage, are less effective.
“This is a chronic disease, 80-90% cannot be cured but will be treated for life”, said Dr. Huyen.