Cervical Dystonia

cervical dystoniaI think my case is unique insofar that my condition is almost cured against all odds of Western medicine – KA

Dystonia disrupts the nervous system’s ability to allow the brain and muscles to communicate. How the body controls muscle movement is very complicated and involves many areas of the brain.

The areas of the brain believed to be most affected by dystonia are called the basal ganglia.

The basal ganglia check the speed of movement and control unwanted movements. They are responsible for sending signals to muscles, instructing them when to move, and when to stop moving. For reasons not yet fully understand, in dystonia, the basal ganglia’s instructions to muscles become irregular and chaotic, resulting in unwanted muscle movements and contractions (see video example) ■

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Non-Coeliac Gluten Sensitivity

He even went through periods where he could not walk properly – CK

non-celiac gluten sensitivityI’ve been told personally that a little gluten never hurt anyone. Clinical experience proves otherwise. The combination of misunderstanding, ignorance and rise in everything pervasively gluten-free has made the topic seem like a modern day fad. Unfortunately, this phenomenon affects those most for whom gluten sensitivity is a real, clinical issue.

It is now becoming clear that, besides those with coeliac disease or wheat allergy, there are people with gluten sensitivity in whom neither allergic nor autoimmune mechanisms can be identified1. It has been estimated that for every person with coeliac disease there should be at least 6 or 7 people with non-coeliac gluten sensitivity (NCGS)1. In 2011 in London, a panel of 15 experts announced a new classification of gluten-related disorders (see yellow boxes below) that was then published in February 20122. The Second Expert Meeting on gluten sensitivity that was held in Munich in 2012, decided to change the name of gluten sensitivity to non-coeliac gluten sensitivity in order to avoid confusion with coeliac disease3.

The challenge with diagnosing NCGS is that currently there are no laboratory biomarkers specific for gluten sensitivity and the diagnosis is based mainly on exclusion criteria: elimination of gluten-containing foods from the diet and monitoring symptoms. Occasionally people will say they have attempted a gluten-free diet, yet symptoms persist. The problem with this is, firstly, foodstuffs nowadays are a complex minefield of chemicals and people may exhibit cross-reactivity with other wheat-based molecules and, secondly, the person may not have been strict enough with the diet or persisted long enough to heal the gut. Being completely gluten-free is incredibly challenging and often too difficult, so alternative diagnoses to gluten sensitivity are sought and the underlying issue is missed.

Many people that are intolerant of gluten are also intolerant of other proteins found in foods like dairy, eggs, and even coffee and milk protein. Critics of the gluten-free diet argue that people with irritable bowel syndrome (IBS) are not sensitive to gluten, but instead are reacting to a group of poorly absorbed carbohydrates called FODMAPs4 (figure below). From a practical perspective, wheat and many other gluten-containing grains are FODMAPs and should be avoided by people with gluten sensitivity anyway.

IBS FODMAPS

Coeliac disease is easier to diagnose than NCGS. Most doctors today know how to screen for coeliac disease. They will typically test for antibodies to alpha gliadin, transglutaminase-2, deamidated gliadin, and endomysium, and if positive do a biopsy to determine if tissue damage is present. However, we now know that people can (and do) react to several other components of wheat above and beyond alpha gliadin, the component that is implicated in coeliac disease. These include other epitopes of gliadin (beta, gamma, omega), glutenin, wheat germ agglutinin (WGA), gluteomorphin, and deamidated gliadin5,6.

The bottom line is standard blood tests by general practitioners are not comprehensive enough. The person may be reacting to deamidated gliadin, glutenin, gluteomorphin, and either transglutaminase-3 or -6, but not reacting to alpha gliadin or transglutaminase-2 (the antibodies used to screen for coeliac disease by most doctors). They will remain undiagnosed and continue to eat gluten for the rest of their lives, suffering symptoms and putting themselves at serious risk for autoimmune diseases.

The typical presentation of NCGS is a combination of IBS and systemic manifestations like headache, joint and muscle pain, muscle contractions, leg or arm numbness, chronic fatigue, “brain fog”, body mass loss and anaemia. Symptoms can also include behavioural disturbances such as changes in attention or depression2 (Table of NCGS symptoms).

IBS can include abdominal pain, nausea, bloating, flatulence, diarrhoea or constipation. People with IBS who respond well to a gluten-free diet can suffer from one of the three diseases: coeliac disease, wheat allergy or NCGS, where NCGS is the most likely option (figure above). In children, NCGS manifests with intestinal symptoms – abdominal pain and chronic diarrhoea – but also symptoms beyond the gut.

Extragastrointestinal manifestations seem to be less frequent but the most common is chronic tiredness. When a person with NCGS consumes wheat or other gluten-containing foods, he or she may not always experience the classic digestive symptoms associated with gut because they do not produce antibodies to transglutaminase-2 (which is mostly expressed in the gut). Instead, the intolerance of wheat may manifest in skin conditions like eczema or psoriasis; and in neurological or brain-related conditions like depression, peripheral neuropathy (pain, numbness, burning, tingling), ataxia (difficulty walking) or ADHD7. Current evidence suggests that neurological manifestations are immune-mediated and that there is cross-reactivity between immune cells, nerve cells and gluten proteins.

Gluten sensitivity is a common disorder that manifests in diverse ways, making it a difficult condition to diagnose. Many people who present with neurological manifestations of gluten sensitivity have no gastrointestinal symptoms7

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Vertigo following whiplash

whiplash upper cervical neck chiropractor

The forces imposed on the cervical spines of passengers of colliding vehicles are tremendous and the damage to the vehicles is no indication of the extent of injury imposed on them.

Research this year also showed in children ages 12 and younger, falls were the most common cause of head injuries. In children under age 2, falls accounted for 77 percent of such injuries; in those 2-12, falls were the cause of 38 percent of head injuries1.

Neck trauma can lead to chronic pain syndrome, including pain decades later.

Signals from nerve endings (proprioceptors) in the neck participate in the co-ordination of eye, head, and body posture, as well as spatial orientation2.

The neck contains systems directly involved in balance control (neck afferents), blood pressure, and heart rate (carotid bodies). Neck movements are invariably linked to head movements, therefore, experiencing unsteadiness, light headedness or vertigo can come from the neck due to alterations in the following mechanisms:

Simple version

  • Inner ear balance
  • Eye co-ordination
  • Blood pressure
  • Nerve signals
  • Body position sense

In people with whiplash injury, the nerve endings of the neck become over excited and start sending mixed messages to the brain and brainstem. There are also other nerve endings around the spine related to one’s fight/flight system which can change temperature, cause inflammation and make muscles really tight. Poor neck motion and tight muscles changes the way information is sent to the brain and perception of where your is head is in relation to your body becomes altered.

Your neck communicates with your inner ear to create a complete picture of space relative to your posture. When there is a mismatch of information coming from the neck and inner ear into the brain, the result is known as cervical vertigo.

head-injury auckland chiropractorPeople with neck pain, poor neck motion, or a history of whiplash injury (sometimes years ago) will be more prone to cervical vertigo.

Complex version

  • Vestibular function
  • Visual spatial orientation
  • Cardiovascular control
  • Neurovascular control
  • Proprio-autonomic reflexes

In people with whiplash injury, there is hyperexcitation of the cervical proprioceptors on one hand, and dysfunction of the central nervous system, such as the hypothalamus, brain stem and cerebellum, on the other. These two factors induce disequilibrium by a trigger-and-target relationship in which the proprioceptors act as a trigger and the central nervous system acts as a target.

Abnormal autonomic reflexes in people with whiplash injury can be explained not only due to hyperexcitation of the cervical sympathetic nerves, but also that of cervical and lumbar proprioceptors. In other words, these reflexes are considered proprio-autonomic reflexes. These reflexes are more evident in people with cervical pain.

Cerebellar symptoms can also manifest by hyperexcitation of cervical proprioceptors. Hypertonicity of cervical and lumbar erector muscles in people with whiplash injury can be explained not only due to hyperexcitation of gamma fibres, but also that of sympathetic nerves in these muscles. This hypertonicity affects the central nervous system, causing disequilibrium following whiplash injury3.

References:

  1. Quayle, S. K. Epidemiology of blunt head trauma in children in U.S. Emergency Departments. N Engl J Med. 2014 371: 1945-1947.
  2. Brandt, T., et al. Cervical vertigo. J Neurol Neurosurg Psychiatry. 2001 71: 8–12.
  3. Hinoki, M. Vertigo due to whiplash injury: a neurotological approach. Acta Oto-laryngologica Supplementum. 1984 419: 9-29.


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