title: Integration of Osteopathic Manual Treatments in Management of Cervical Dystonia with Tremor: A Case Series.
abstract: BACKGROUND
  Cervical dystonia, also known as spasmodic torticollis, is a chronic disorder in which patients exhibit involuntary repetitive contractions of neck muscles resulting in abnormal postures or movements. Occasionally, there is also a dystonic head tremor. The underlying mechanisms for cervical dystonia and dystonic tremor are not clear, and treatments are limited.
  
  
  METHODS
  In the present cases, two females with head tremor starting in adolescence developed worsening symptoms of cervical dystonia with dystonic tremor in their 60s. On osteopathic physical examination, both had a vertical type strain to the sphenobasilar synchondrosis.
  
  
  CONCLUSIONS
  Vertical strains are more frequently found in patients after head trauma, congenital or later in life, than in healthy patients, and head trauma may have been a precipitating factor in these patients. There were improvements in cervical dystonia symptoms, including tremor, in both patients after osteopathic manual treatment.
authors.affiliation: College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY, USA.
authors.forename: Miriam
authors.initials: M
authors.lastname: Halimi
authors.affiliation: College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY, USA.
authors.forename: Adena
authors.initials: A
authors.lastname: Leder
authors.affiliation: College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY, USA.
authors.forename: Jayme D
authors.initials: JD
authors.lastname: Mancini
keywords: Tremor; botulinum toxins; craniocerebral trauma; movement disorders; osteopathic manipulation; spine; torticollis