(Spasmodic Torticollis; Cervical Dystonia)
Torticollis is a chronic condition in which the neck muscles contract involuntarily. This causes the head to turn and tilt to one side, and the chin to point to the opposite side. Sometimes one shoulder is lifted. The muscle contraction may be constant (fixed) or may come and go (intermittent). The abnormal posture caused by tilting the head may lead to neck pain.
Torticollis may be present at birth (congenital) or develop later in life (acquired).
The causes are not well understood. Researchers are investigating genetic, environmental, or other underlying mechanisms that may play a role.
Causes may include:
- Genetic defect
- Infant's position during pregnancy or delivery
- Head or neck injury
- Damage or malfunction of the nervous system, specifically the basal ganglia, which is a deep brain structure
- Inner ear or eye problems
- Deformities of the bones or muscles in the neck
- Tumors of the head]]> or neck
- ]]>Arthritis]]> of the neck
- ]]>Gastroesophageal reflux in infants]]> (passage of acid from the stomach into the throat)
Use of certain medications, including:
These factors increase your chance of developing this condition. Tell your doctor if you have any of these risk factors:
- Sex: female
- Age: newborn and children under age 10
- Age: adults aged 30 to 60 years
- Family member with torticollis or similar disorders
Symptoms may include:
- Rotation and tilting of the head to the affected side
- Enlargement of neck muscles, possibly present at birth
- Stiffness of neck muscles
- Painful spasms of neck and upper back muscles
- Limited range of motion of the head and neck
Muscles of the Neck
Torticollis ranges from mild to severe. It usually progresses slowly for 1-5 years, and then plateaus. However, torticollis may persist for life and can result in limited movement and deformed posture.
The doctor will ask about your symptoms and medical history, and perform a physical exam.
Tests may include:
- X-rays]]> of the neck—a test that uses radiation to take a picture of structures inside the body
- ]]>CT scan]]> of the neck—a type of x-ray that uses a computer to make pictures of structures inside the body
- ]]>MRI scan]]> of the neck—a test that uses magnetic waves to make pictures of structures inside the body
The treatment for torticollis depends on whether it is congenital or acquired. Treatment generally centers on physical therapy, oral medication, botulinum toxin injections, and surgery. Possible treatments may include:
- Positioning of the infant to avoid sleeping on one side
- Positioning of toys to encourage turning of the head
- Stretching exercises several times each day
- In some situations, surgery to cut the muscle that causes torticollis
- Deep brain stimulation surgery
- Identifying the cause
- Physical therapy to help relax the muscle and reduce pain
- In some situations, surgery to cut the nerve to the muscle that is in spasm
- Anticholinergic drugs, such as trihexyphenidyl (Artane)]]> , ]]>benztropine (Cogentin)]]> , and ethopropazine (Parsitan)
- Dopaminergic drugs that increase dopamine levels, such as ]]>levodopa (Sinemet or Madopar)]]> or ]]>bromocriptine (Parlodel)]]> , or conversely, drugs that decrease dopamine levels such as, ]]>clozapine (Clozaril)]]> and ]]>tetrabenazine (Nitoman)]]>
- Benzodiazepines that block Gaba-A receptors, such as diazepam ]]>(Valium)]]> or ]]>clonazepam]]> (Klonopin)
- Injection of ]]>botulinum toxin]]> to weaken or partially paralyze the muscle—This may help improve neck posture, but only if begun soon after torticollis begins. The drug's effect wears off after several months and treatment must be repeated.
- Injection of alcohol or phenol to deaden the nerve that causes the muscle contraction
Each of these options has risks and benefits. Work with your doctor to find the right treatment for you.
Dystonia Medical Research Foundation
National Spasmodic Torticollis Association
Worldwide Education and Awareness for Movement Disorders
Canadian Family Physician
Beers MH, Berkow R. The Merck Manual Diagnosis and Therapy . 17th ed. Whitehouse Station, NJ: Merck & Co; 1999.
Collins A, Jankovic J. Botulinum toxin injection for congenital muscular torticollis presenting in children and adults. Neurology . 2006;67:1083-1085.
Corrado G, Fossati C, Turchetti A, Pacchiarotti C, Nardelli F, D'Eufemia P. Irritable oesophagus: A new cause of Sandifer's syndrome. Acta Paediatr . 2006;95:1509-1510.
Herman MJ. Torticollis in infants and children: common and unusual causes. Instr Course Lect . 2006;55:647-653.
National Institute of Child Health and Human Development website. Available at: http://www.nichd.nih.gov/ .
National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/ .
Preto TE, Dalvi A, Kang UJ, Penn RD. A prospective blinded evaluation of deep brain stimulation for the treatment of secondary dystonia nad primary torticollis syndromes. J Neurosurg. 2008;109:405-409.
Last reviewed January 2009 by ]]>Rimas Lukas, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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