Adult torticollis which is also referred to as cervical dystonia or spasmodic torticollis is a condition in which the muscles that control the neck are locked into a sustained involuntary contraction.
These contractures can generally cause twisting, repetitive movements, or abnormal posturing of the neck. Depending on the severity, it can be a very painful condition that may further lead to a great deal of distress.
Presentations of torticollis are defined using causal terms such as acute, congenital, chronic, acquired, idiopathic, or secondary.
Adult torticollis which is also referred as cervical dystonia presents as the rotation of the head or chin towards the shoulder. Repetitive jerking of the head may be present with spasms that can be intermittent, or tremulous.
Cervical dystonia can cause disabling pain and most patients exhibit a lack of postural control. Unlike other dystonias, cervical dystonia will present with pain around 75% of the time.
Alterations in vestibular function and perception of body orientation, such as differences in the vestibular ocular reflex, vestibular hyper-reactivity, and trouble recognizing postural and visual verticality may be present.
The symptoms have been known to change in nature and direction. In torticollis, the side that the chin rotates to decides how the condition is described. For example, if the chin is turned to the left then it would be described as “left turning torticollis”.
In cervical dystonia, the neck muscles contract involuntarily. If the shrinkage is sustained, they may cause unusual posture of the head and neck. If the pain is periodic or regular, they may produce jerky head movements.
The severity of cervical dystonia varies from mild to severe. Movements are often partially relieved by a sensory trick such as gently touching the chin, other areas of the face, or back of the head.
Cervical dystonia may originate in the neck and further spread into the shoulders, but the symptoms usually plateau and remain stable within five years of onset.
This form of focal dystonia is unlikely to spread beyond the neck and shoulders or become generalized dystonia. Occasionally, people with cervical dystonia develop other focal dystonias.
Cervical dystonia may be primary (meaning that it is the only apparent neurological disorder, with or without a family history) or be brought about by secondary causes such as physical trauma.
Instances of inherited cervical dystonia may occur in conjunction with early-onset generalized dystonia, which is associated with the DYT1 gene.
Diagnosis of cervical dystonia is based on information from the affected individual and the physical and neurological examination.
At present, there is no test to confirm the diagnosis of cervical dystonia and in most cases assorted laboratory tests are normal.
Cervical dystonia should not be confused with other conditions which cause a twisted neck such as local orthopedic or congenital problems of the neck, or ophthalmologic conditions where the head tilts to compensate for impaired vision. Cervical dystonia is mostly misdiagnosed as stiff neck, arthritis, or wry neck.