Questions posted in the Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.

Subject: Re: puzzled re. recent diagnosis
Forum: The Neurology and Neurosurgery Forum
Topic Area: Obsessive
Posted by CCF MD mdf on September 17, 1998 at 21:40:28:
In Reply to: puzzled re. recent diagnosis posted by Robert on September 17, 1998 at 20:54:52:



Recently I saw my primary care physician and described to him what I felt
to be neurological disorder that I have had as long as I can remember, but
has recently started to interfere with my day to day activities. The best
way I can describe the problem is an oversensitivity in my neck that feels
like I am being tickled even when nothing is touching it, that prompts
me to hold my neck with my hand to relieve the sensation. Recently,
however, holding my hand to my neck has not provided the usual relief,
and I have even been awoken twice by this sensation, that seems to
originate on the surface of the neck and persist on the timescale of
minutes. The more I try to forget about it, the more it bothers me. I
have a younger and older sibling with the identical problem, although
neither of my parents seem to have the problem.

The doctor feels that this might be a symptom of OCD, and has referred
me to a neurologist. He also suggested I look up some information on
the subject to learn more. From my reading however, OCD seems to
involve primarily obessive thoughts and compulsions that seem to be
much "higher level" (e.g. hand-washing, sorting, etc). I also have
studied the symptons of Tourette's syndrome and couldn't find a
real match in any of the materials I read. The symptoms there
primarily involved vocal outbursts and nervous jerking motions,
neither of which seem to fit the problem.

I'd really be interested if you have insight into this disorder,
especially since a hard search on the internet has not produced
any leads. I do once recall several years ago seeing someone
in the subway holding their turtle neck up to their chin and
wondering if this person had a similar "neck problem". I should
also mention that the dentist office and barber shop present obvious
problems, as I can't stand for a bib to be wrapped around my neck.

Anyway, any help/suggestions for relief would be MUCH appreciated.

Thanks in advance.

=

This is indeed puzzling.

I don't know that I would make a diagnosis of OCD solely on the strength of this one symptom. I suppose conceivably that unusual sensations such as this could be part of OCD.

The uncontrollable sensation (urge) and the voluntary movement that follows it is characteristic of tics. You may have simple motor tics. As you read, Tourette syndrome is a more complex tic disorder involving multiple types of motor tics with vocal tics. Incidentally, there is a high concordance of Tourette syndrome with OCD.

People with cervical dystonia, also called spasmodic torticollis, often develop a sensory "trick" to inhibit the abnormal movements. In their case, the jerking or steady abnormal neck posture (for example, turned to one side) is the "primary" problem, and they have learned that sensory input (holding a hand up to their chin) can allow their head posture to normalize. I don't think that's what is going on in your case, but it is worth mentioning.

Tic disorders often run in families. I believe OCD may do so also. Certain syndromes of dystonia (the one I mentioned is only one of many types) can run in families.

It's hard to advise you whom to see. Perhaps a movement disorders specialist could help you. At the very least, one could tell you what this is not. Tic disorders are often difficult to treat, but there are some options which may work.

If you are interested, you are welcome to call 800 223-2273 and ask for neurology appointments at ext 4-5559. Tell them you want a movement disorders specialist or a Tourette syndrome specialist.

As you know, this forum can't substitute for medical advice from your doctor. I hope this helps. CCF MD mdf.


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