News Letter, Vol. 8 (1), March, 2017, © Copyright
Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.
Rehabilitation Medicine and Acupuncture Center
1171 East Putnam Avenue, Building 1, 2nd Floor
Greenwich, CT 06878, Tel: (203) 637-7720
Lisa L. is an 18-year-old female, who had been complaining of neck pain for the past six years. The patient reports that, six years ago, when she woke up, she suddenly realized that her neck jerked to the left. The jerk happened very often; her neck would jerk two or three times every 5-10 minutes. The jerk was involuntary and occurred more frequently especially when she was tired or under stress. However, if she had a good night’s rest, felt energized, and focused on something (e.g. her favorite sports), she would not experience the sudden, involuntary neck movements. Only when she sat still, did her neck start to jerk.
Lisa’s neck muscle always feels very tight, and the tightness can be very painful. She has been to many doctors and has tried everything, such as physical therapy and multiple medications, without any improvement. She therefore came to me for evaluation and treatment. Upon physical examination, I noted that the left side of the patient’s sternocleidomastoid muscle had hypertrophied. It felt like a thick rope on the left side of her neck. I also noted that other muscles had undergone hypertrophy: the levator scapular and splenius capitis at the cervicals. Throughout the entire physical examination, there was no jerk or involuntary contraction on the left side of the patient’s neck.
What Lisa is suffering from is called cervical dystonia, which is the most common form of focal dystonia. Cervical dystonia is characterized by abnormal and spasmodic squeezing of the muscle that leads to muscle contractions in the head and neck area. The movements are involuntary and are sometimes very painful, causing the neck to twist repetitively, resulting in abnormal posture. Overall, this may affect a single muscle, a group of muscles, such as those in the arms, neck, and legs, or even the entire body. Patients with dystonia often have normal intelligence and no associated psychiatric disorders.
The causes of cervical dystonia are currently unknown. There are two types of cervical dystonia:
Primary cervical dystonia: This type of cervical dystonia is not related
to any identifiable, acquired disorders affecting the brain or spinal cord such
as stroke, infection, tumor, or trauma. In some cases, primary cervical dystonia
is genetic, caused by abnormal genes such as dystonia DYT1. However,
because not all carriers of the DYT1 gene develop cervical dystonia, it
is likely that other genes or environmental factors may play a role in the
development of cervical dystonia.
Secondary cervical dystonia: Unlike primary cervical dystonia, secondary
cervical dystonia has obvious causes such as stroke, tumor, infection in the
brain or spinal cord, traumatic brain injury, toxins, birth defect, etc. There
may be a period of months between the injury and the onset of the dystonia.
Tests and diagnosis:
The first step when diagnosing cervical dystonia is to determine if any of the causes that may lead to secondary dystonia are evident. The following tests may be used to screen and/or diagnose for secondary cervical dystonia:
1.Toxins and infections screening: blood or urine samples will confirm the presence of toxins and infections.
2.Tumor screening: an MRI will identify and visualize tumors of the brain or spinal
3.Genetic testing: can be used to identify DYT1, which is critical to the diagnosis
of primary cervical dystonia.
4.Electromyography (EMG) testing: measures electrical activity of muscles. An EMG can help diagnose muscle or nerve disorders.
Many different medications have been used to treat cervical dystonia but most are not effective:
1.Cogentin and Kemadrin are examples of drugs that decrease the level of acetylcholine. These have helped some patients but have sedating side effects.
2.Valium, Ativan, Klonopin, etc., regulate the neurotransmitter GABA.
3.Sinemet, Laridopa, etc. either increase or decrease dopamine levels.
4.Carbamazepine is an anticonvulsant.
Botox injections can usually stop the muscle spasms by blocking acetylcholine, relieving the symptoms for approximately three months. Very experienced doctors should administer the Botox injections. If Botox is used for more than a one-year period, it will gradually become less effective because the patient’s body will begin producing auto-antibodies against it.
In some severe cases, surgery may be an option. Surgery is the last resort and is used to selectively denervate the nerve supplying the muscle.
Another treatment option is deep brain stimulation. This involves implanting an electrode in the brain connected to a stimulated device in the chest that generates an electrical pulse. These electrodes will temporarily disable nerve activities by damaging
small areas of the brain.
According to traditional Chinese medicine, cervical dystonia is caused by excessive liver wind. The liver controls the movement of all tendons, muscles and joints in the human body. Excessive liver wind overstimulates the tendons, muscles and joints, constantly activating the muscles. We use the following methods to treat our cervical dystonia patients.
The principle acupuncture treatment used to treat cervical dystonia reduces the excessive liver wind and thereby decreases the activities of the tendons, muscles and joints. The acupuncture points are along the meridians of the liver and gall bladder, such as the Feng Chi and Tai Chong points.
In addition, because patients with cervical dystonia have abnormal head and neck movements, acupuncture must also be used along the Du meridian, which controls head movement. The Du meridian supplies the entire brain. If the energy of the Du meridian is excessive, the entire head will move abnormally. Therefore, the acupuncture treatment should also include the Da Zhui and Hou Ding points from the Du meridian. These points will adjust and regulate the Du meridian, the yang, activate the tendon function, and balance the input and output of the energy of the Du meridian.
The acupuncture treatment should also include the Xin Shu, a direct outlet acupuncture point from the heart and the Shen Shu, a connecting point from the kidney. Sheng Men, Tai Xi and the points listed above are involved in the circuitry of the heart and kidney, and will decrease the fire surrounding these organs, keeping the yin and yang in harmonious balance. Some local points in the neck and head such as Tian Chuang, Tian Rong, Tian Ding, and Fu Tu, should also be used for their localized calming functions.
This combination of local and distal acupuncture points will greatly decrease the symptoms associated with cervical dystonia.
Moxa is a Chinese herb similar to cigarette to warm certain points in the human body. We suggest to use the following device to moxa the neck sternocleidomastoid muscle for 30 minutes. Patients should learn how to use it before you use for yourself.
- Guasha (Scrape) :
Following the length of sternocleidomastoid muscle, use the Guasha plate to scrape down 30 times then up 30 times, 5 sessions per day.
The patient was treated with acupuncture at the above points for approximately two months, three times a week. After the last treatment, the number of neck contractions had significantly decreased. Now, she only experiences mild neck jerks and contractions, allowing her to perform her daily activities in a normal manner.
Tips for acupuncturists:
- Acupuncture cannot treat all forms of cervical dystonia. The milder the disease, the better the treatment results. Physicians should find the cause if the patient is suffering secondary cervical dystonia.
- Using heating pads and massages after the acupuncture treatment increases its effectiveness.
Tips for patients:
1.The earlier the treatment, the better the treatment results.
- Help yourself with Guasha, Moxa, massage and heating pad.