Cervical dystonia

Mary Ann Thenganatt MD (Dr. Thenganatt of the University of Pennsylvania 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, received research funding from Allergan, Allon, Ceregene, Chelsea, EMD Serono, Impax, Ipsen, Lundbeck, Medtronic, Merz, and Teva, and compensation for his services as a consultant or an advisory committee member by Allergan, Auspex, EMD Serono, Lundbeck, Merz, Neurocrine Biosciences, and Teva.)
Originally released September 6, 1993; last updated April 4, 2016; expires April 6, 2019

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 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 also emerged as a potential therapy 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. 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). "Torticollis" is a term used to describe a mixed group of conditions associated with a wry neck. Earlier in this century, torticollis was regarded as psychogenic (Patterson and Little 1943); however, the organic nature of cervical dystonia is widely accepted.

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