Cervical dystonia in the form of severe Dropped Head Syndrome sees resolution using Carrick Eye Movements and novel vestibular therapy
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Dr. Shannon Leon Functional Neurology, United States
Presentation
Patient presents with working diagnosis of Dropped Head Syndrome, and prior to arrival had been treated for over a year and half with physical therapy and acupuncture to no attenuation of symptoms. Of note, patient reports head trauma from a fall one year prior to onset of cervical dystonia. Comorbidities include bilateral knee replacements seven years prior to arrival to clinic, prescription-controlled hypertension, and right leg cramps for forty years. Clinical examination highlights reveal left laterocollis with left torticollis, right eye accommodation in neutral gaze, left eye hypertropia, and resting nystagmus right beating alternating with up-right beating.
Intervention
This patient presented an overall unique phenomenological challenge due to past therapies that created metabolically efficient pathological muscle tone. In response, we treated biomarkers that would exhibit contralateral expression following a number of treatments, and so we rectified layers and hierarchies of compensatory neural reflexes until the nidus of the lesion became resolvable and resolved. Early stages of intervention involved passive cervical sinusoidal head movements about a fixed gaze target, and these were effective in-office but unable to create lasting relief beyond a few days; we believe that many dozens of past physical therapy treatments involving manual fascial lengthening created such tonic windup that it rendered our passive treatments meager in comparison, albeit centrally accurate. Final stage intervention focused on neutralizing the biomarker of resting gaze beating nystagmus up and right. This was done by initiating the left anterior semicircular canal vestibo-ocular reflex with a spinning chair and perseverating those reflexes with up-left Carrick Eye exercises, up-left Brock string, pursuit down-right of patient’s own hand, and repetitive somatic stimulation of left hypoglossal nerve.
Outcome
Patient now holds neck in neutral posturing without effort and without fatigue during all stages of gait and station. He can see the horizon (and above) when he walks and he can make eye contact during conversation. He has returned to normalcy in all activities of daily living questioned.
Perspective
Receptor-based inputs yield global brain consequences and should be directed in deliberate manner. In this patient model, we see that end organ-centric manual therapy to dystonic cervical musculature leads to short term fascial lengthening and to long term neuroplasticity of pathological muscle tone via repeated distortion of fine collicular maps (maps already distorted if exposed to previous trauma). We can learn a lesson of finesse here for future models of gross bodily distortion. It is our intent to raise worldwide standards for human care above those which have allowed for maintenance of many chronic conditions and overall loss of quality of life. This patient shows us that skillfully directed gaze points will conduct cervical stance more resolutely than will manual effort.
Keywords:
Cervical dystonia,
Dystonia,
dropped head syndrome (DHS),
Physical therapy (specialty),
carrick eye exercises,
Head & eye movement,
Head- and eye movement
Conference:
International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019.
Presentation Type:
Poster Presentation
Topic:
Clinical Neuroscience
Citation:
Leon
S and
Langhough
J
(2019). Cervical dystonia in the form of severe Dropped Head Syndrome sees resolution using Carrick Eye Movements and novel vestibular therapy.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience.
doi: 10.3389/conf.fneur.2019.62.00016
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Received:
30 Mar 2019;
Published Online:
27 Sep 2019.
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Correspondence:
Dr. Jason Langhough, Dr. Shannon Leon Functional Neurology, Woodbury, Minnesota, 11797, United States, j.langhough@gmail.com