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Chronic neck contractions with no diagnosis - Conversion disorder?
Has anyone seen this problem? Chronic neck contractions draw the head straight back, no twisting.
Began only at rest lying down and were not jerking, but a rather quick contraction that could be released by concentrating or by massage.
Steadily got worse and couldn't be relieved by massage,
patient had trouble falling asleep. At first, Ambien and benzodiazapines were enough.
At first, the patient was ok when sitting or standing.
Then the spasms/contractions got worse and carried over while patient was sitting or standing.
Now patient can only relieve them, interestingly, by doodling while sitting up or by actively searching the computer.
Contractions are especially bad when driving or riding in car. (Can't drive anymore.)
Contractions are bad when watching television or watching things on a computer, but when actively searching for things on the computer, they go away.
Patient has tried Primary Care Physician, PMR therapists and doctors ("not my patient"), chiropractors, neurologists (four including head of movement disorders at University of Michigan), BOTOX (this may have helped, but they start with tiny dose and can only increase it every three months), biofeedback, psychotherapy.
Neurologists said they can find no physical cause and suggest somatic condition. Ruled out Cervical Dystonia, but no blood or urine tests were done.
Psychiatrist gives patient lots of Zoloft and Desipramine through a NP, but hasn't had time to see her in 2 months. Nonetheless, he has diagnosed her with Conversion Disorder and cancelled CBT therapy, but scheduled no other kind of therapy.
Patient has worked on her own to find a Biofeed back therapist. Spasms are relieved during actual session, but it doesn't last and the treatment doesn't seem to have a real program behind it with goals and stategies.
Patient has found PhD psychotherapist to work on possible psychological component.
Chiropractor has seen subluxations (second chiropractor) and has requested better spine xrays after his low quality xray machine detected something that looked suspicious.
Patient was on Paxil for 12 years for OCD.
Patient has history of traumatic auto accidents at ages 3 and 7.
Patient has parental issues, perhaps quite worse than average.
Patient has bad marital history.
Patient has handicapped son.
Patient has hypothyroidism and is on levothyroxin and T3/T4.
Patient has been vaguely diagnosed with Chronic Fatigue and perhaps Fibromyalgia.
This is a very debilitating condition.
Neck spasming during all waking hours and keeping you awake at night until benzos and/or ambien and muscle relaxants can knock you out.
Condition only relieved by doodling on paper while talking and searching actively on the computer. Sometimes by working outside in the yard for a while, although CFS makes this problematic.
Began only at rest lying down and were not jerking, but a rather quick contraction that could be released by concentrating or by massage.
Steadily got worse and couldn't be relieved by massage,
patient had trouble falling asleep. At first, Ambien and benzodiazapines were enough.
At first, the patient was ok when sitting or standing.
Then the spasms/contractions got worse and carried over while patient was sitting or standing.
Now patient can only relieve them, interestingly, by doodling while sitting up or by actively searching the computer.
Contractions are especially bad when driving or riding in car. (Can't drive anymore.)
Contractions are bad when watching television or watching things on a computer, but when actively searching for things on the computer, they go away.
Patient has tried Primary Care Physician, PMR therapists and doctors ("not my patient"), chiropractors, neurologists (four including head of movement disorders at University of Michigan), BOTOX (this may have helped, but they start with tiny dose and can only increase it every three months), biofeedback, psychotherapy.
Neurologists said they can find no physical cause and suggest somatic condition. Ruled out Cervical Dystonia, but no blood or urine tests were done.
Psychiatrist gives patient lots of Zoloft and Desipramine through a NP, but hasn't had time to see her in 2 months. Nonetheless, he has diagnosed her with Conversion Disorder and cancelled CBT therapy, but scheduled no other kind of therapy.
Patient has worked on her own to find a Biofeed back therapist. Spasms are relieved during actual session, but it doesn't last and the treatment doesn't seem to have a real program behind it with goals and stategies.
Patient has found PhD psychotherapist to work on possible psychological component.
Chiropractor has seen subluxations (second chiropractor) and has requested better spine xrays after his low quality xray machine detected something that looked suspicious.
Patient was on Paxil for 12 years for OCD.
Patient has history of traumatic auto accidents at ages 3 and 7.
Patient has parental issues, perhaps quite worse than average.
Patient has bad marital history.
Patient has handicapped son.
Patient has hypothyroidism and is on levothyroxin and T3/T4.
Patient has been vaguely diagnosed with Chronic Fatigue and perhaps Fibromyalgia.
This is a very debilitating condition.
Neck spasming during all waking hours and keeping you awake at night until benzos and/or ambien and muscle relaxants can knock you out.
Condition only relieved by doodling on paper while talking and searching actively on the computer. Sometimes by working outside in the yard for a while, although CFS makes this problematic.
I was wondering if the problem is already diagnosed. But this sounds a lot like what I have. I was diagnosed with conversion disorder in januari 2011 after spending 4 days in hospital in nov 2010 with arm and nek spasm. When i am sleeping my body does not spasm but as soon as I woke up. It would begin. Closing my eyes and focusing on finding rest makes it go down.
One last thing...any facial movements (like tics?) during the neck contractions? No other spasms/rigidity/tremors anywhere else?
IMO, this patient needs a complete NEW work-up by new specialists for a fresh perspective. The activities that seem to "relieve" the symptoms (doodling, searching pc) would lead me to more of a psych Dx as well, as most Neuro symptoms would not be relieved so easily with non-specific activities (that would have random positioning/movement). Also, this patient has a LONG history of a traumatic past and a lot of stress and a concurrent OCD Dx. I would recommend the pt be worked up by an Endocrinologist and Neurologist, with a thorough battery of lab tests....just to start.
Difficult case for sure, I hope she gets relief.
How old is the patient? Any family history of chronic conditions?
Difficult case for sure, I hope she gets relief.
How old is the patient? Any family history of chronic conditions?
Paxil's Freaky Rare Side Effects: Complete loss of taste , enlargement of skin, (reflexes increased) tongue discoloration. They probably left a few out like Neck spasms but ofcoarse that could be 2% of the population and she just happens to fall in that 2%. I don't know,its something to think about.
this sounds like one of those take a pill for this problem and gain another and another and another. maybe find the real problem instead of pumping them full of foriegn substances might help, just sayin'.
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