Dear Sood,
How sudden is sudden? Was there any evidence however mild of previous
neck problems (seen visually) from the patients relatives as it can go
unnoticed by the patient. The present symptoms will probably deteriorate as
secondary problems arise with persistent abnormal muscle activity and
changes to joint structures.
I have seen several patients with this form of dystonia. You need to
investigate further . I use a dual channel surface EMG to analyse
sternocleidomastoid.
1.Check for asymmetrical activity. Regular Spikes in the abnormal side and
decreased activity in the other. It might be possible to analyse this in an
upright position compared to a lying position and with the patient awake and
asleep. Expect a decrease in the EMG with decreased weight bearing of the
neck. I have not had the opportunity to look at it in sleep and cannot
recall any papers on this subject.
2. Expect the response to stretching passively of the affected
sternocleidomastoid to increase the EMG activity. Hold relax or
contract
relax of the non-affected sternocleidomastoid to decrease the EMG.
The use of EMG has good benefits (not curative) as a form of biofeedback
which the patient can easily identify with and not attempt to fight the
contractions. It enables the user to 1) decrease the tone and the spikes of
activity and 2) increase the normal activity of the opposite
sternocleidomastoid. Perhaps there has been something in your
patients life that has triggered of a problem just waiting to happen? Check
with the
research on toxin and rhizotomy use carefully. I have treated one of the
earliest patients to undergo these same procedures (in this area) and
despite a surgical intervention the dystonia reoccurred years later and then
after several toxin interventions caused a major complication suffice to
stop its administration. I am unaware of any work on long term prognostics
for these with very severe symptoms.
In conjunction with this relaxation is important, to wean off the
biofeedback though some of my patients have purchased portable units (using
auditory feedback).
Yours sincerely
Kevin Wright,
MCSP
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