Acquired torticollis (cervical dystonia) is a rare, typically idiopathic, brain disorder causing involuntary neck movements.
Often associated with pain.
Patients may be able to relieve their symptoms by touching their neck, head, or face in a certain way (sensory trick).
Targeted intramuscular injection of botulinum toxin is the therapy with the best proven efficacy. Oral medications and physical therapy may also have a role in the treatment of the condition.
Treatment options for refractory acquired torticollis include deep brain stimulation, radiofrequency ablation, selective surgical denervation, chemical denervation, and intrathecal baclofen.
Acquired torticollis, also known as cervical dystonia, is a focal abnormality of muscle tone that originates in the brain. It is characterized by involuntary contraction of neck muscles, abnormal neck movements, and an awkward posture of the head and neck. It is frequently associated with pain in the associated muscle groups.
History and exam
Key diagnostic factors
- involuntary twisting or deviation of the neck
- neck pain
- presence of sensory trick
- abnormal head posture
- otherwise normal neurologic exam
Other diagnostic factors
- head tremor
- insidious onset
- asymmetrical hypertrophy of neck muscles
- normal range of motion (ROM) of neck (early in course)
- female sex
- middle age (40 to 59 years)
- white ancestry
- family history of acquired torticollis
- exposure to dopamine-blocking drugs
- history of trauma
1st investigations to order
- clinical diagnosis
Investigations to consider
- cervical x-rays
- CT or MRI of the brain
- CT or MRI of the neck
- DYT-1 gene
- serum ceruloplasmin, urinary copper excretion
without pain or functional impairment
with functional impairment or pain or diminished quality of life
refractory to therapy with botulinum toxin
David B. Sommer, MD, MPH
Neurologist and Movement Disorder Specialist
Reliant Medical Group
DBS declares that he has no competing interests.
Dr David B. Sommer would like to gratefully acknowledge Dr Mark A. Stacy, a previous contributor to this topic.
MAS has received speaking honoraria and consulting fees from Allergan, the manufacturer of Botox; he has received research grant support from Ipsen, manufacturer of Dysport, and Merz, manufacturer of Xeomin; he is an author of a reference cited in this topic. Duke University has received funding from Allergan for a continuing medical education program.
Allison Brashear, MD
Professor and Chair
Department of Neurology
Wake Forest University Baptist Medical Center
AB declares interests in Allergan; she is an author of a reference cited in this topic.
Robert Werner, MD
Chief of PM&R
Ann Arbor VA Medical Center
RW declares that he has no competing interests.
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- Practice guideline update summary: botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache
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