This is a case presentation of a patient with cervical dystonia of long duration. Following a consultation the patient elected to learn to Self-Administer Sphenopalatine Ganglion Blocks to treat her pain.
The Sphenopalatine Ganglion (SPG) is the largest Parasympathetic Ganglion of the head and has cell bodies of parasympathetic nerve fibers in thee ganglion. It also contains nerve fibers from the superior cervical chain and pass thru the SPG. It also contains somato-sensory nerves of the trigeminal nervous system.
There is over 100 year history of using Sphenopalatine Blocks to treat a wide variety of chronic pain disorders as well as disorders related to the autonomic nervous system.
The following video is a patient describing her initiation into utilizing SPG Blocks for treating pain:
Modulation of Muscle Tone and Sympathovagal Balance in Cervical DystoniaUsing Percutaneous Stimulation of the Auricular Vagus Nerve.
Primary cervical dystonia is characterized by abnormal, involuntary, and sustained contractions of cervicalmuscles. Current ways of treatment focus on alleviating symptomatic muscle activity. Besides pharmacological treatment, in severe cases patients may receive neuromodulative intervention such as deep brain stimulation. However, these (highly invasive) methods have some major drawbacks. For the first time, percutaneous auricular vagus nerve stimulation (pVNS) was applied in a single case of primary cervical dystonia. Auricular vagus nerve stimulation was already shown to modulate the (autonomous) sympathovagal balance of the body and proved to be an effective treatment in acute and chronic pain, epilepsy, as well as major depression. pVNS effects on cervical dystonia may be hypothesized to rely upon: (i) the alteration of sensory input to the brain, which affects structures involved in the genesis of motoric and nonmotoric dystonic symptoms; and (ii) the alteration of the sympathovagal balance with a sustained impact on involuntary movement control, pain, quality of sleep, and general well-being. The presented data provide experimental evidence that pVNS may be a new alternative and minimally invasive treatment in primary cervical dystonia. One female patient (age 50 years) suffering from therapy refractory cervical dystonia was treated with pVNS over 20 months. Significant improvement in muscle pain, dystonic symptoms, and autonomic regulation as well as a subjective improvement in motility, sleep, and mood were achieved. A subjective improvement in pain recorded by visual analog scale ratings (0-10) was observed from 5.42 to 3.92 (medians). Muscle tone of the mainly affected left and right trapezius muscle in supine position was favorably reduced by about 96%. Significant reduction of muscle tone was also achieved in sitting and standing positions of the patient. Habituation to stimulation leading to reduced stimulation efficiency was observed and counteracted by varying stimulation patterns. Experimental evidence is provided for significantly varied sympathovagal modulation in response to pVNS during sleep, assessed via heart rate variability (HRV). Time domain measures like the root mean square of successive normal to normal heart beat intervals, representing parasympathetic (vagal) activity, increased from 37.8 to 67.6 ms (medians). Spectral domain measures of HRV also show a shift to a more pronounced parasympathetic activity.
Auricular vagus nerve; Cervical dystonia; Electromyography; Heart rate variability; Neuromodulation; Sympathovagal balance