Cervical dystonia

Isabel Alfradique-Dunham MD (

Dr. Alfradique-Dunham of Baylor College of Medicine has no relevant financial relationships to disclose.

)
Joseph Jankovic MD, editor. (

Dr. Jankovic, Director of the Parkinson's Disease Center and Movement Disorders Clinic at Baylor College of Medicine, has received research and/or training grants from Adamas, Allergan, Biotie, Civitas/Acorda, Hoffmann-La Roche, Medtronic, Merz, Neurocrine , Nuvelution, Pfizer, Prothena, Psyadon, Revance, and Teva; and has served as a consultant or as an advisory committee member for Adamas, Allergan, Merz, Prothena, Revance, and Teva.

)
Originally released September 6, 1993; last updated December 1, 2017; expires December 1, 2020

This article includes discussion of cervical dystonia, idiopathic cervical dystonia, and spasmodic torticollis. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Cervical dystonia is the most common focal dystonia, consisting of involuntary head and neck movements, which result in abnormal postures, tremor, and associated pain. The etiology remains unclear but appears heterogeneous, and this article discusses possible roles played by genetics and trauma. Botulinum toxin injections have been a breakthrough in the treatment of this condition for the last 3 decades. Deep brain stimulation has been an alternative option for intractable cases.

Key points

 

• Cervical dystonia is the most common form of focal dystonia.

 

• Diagnosis is clinical and is based on history and examination.

 

• An underlying cause is usually not identified, although secondary causes, especially drug-induced, should be excluded.

 

• Treatment of choice is botulinum toxin injections and consideration of deep brain stimulation for resistant cases.

Historical note and terminology

The features of cervical dystonia, consisting of abnormal head and neck posture with sustained or intermittent movements, have long been well known. Before the 18th century, several descriptions, sculptures, and paintings depict a possible abnormal position of the neck. Previously known as "spasmodic torticollis," cervical dystonia was defined as "an involuntary hyperkinesis involving the muscles of the neck primarily on one side" (Foltz et al 1959). In 1888, Charcot presented a case of a stockbroker who developed a clonic spasm in the sternocleidomastoid and trapezium after a catastrophic financial loss, which raised the suspicion for psychogenic etiology (Newby et al 2017). It was only in the 20th century that dystonia was separated as an organic etiology.

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