Torticollis (Spasmodic Torticollis, Cervical Dystonia)

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Definition

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).

Causes

The causes of torticollis are not well-understood. Research is actively investigating what role genetic, environmental, or other underlying mechanisms may play in causing torticollis.

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:
    • Phenothiazines
    • Butyrophenones

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.The following increases your risk of torticollis:

Sex: femaleAge: newborn and children under age 10Age: adults aged 30 to 60 yearsFamily member with torticollis or similar disorders Symptoms Symptoms may include: Rotation and tilting of the head to the affected sideEnlargement of neck muscles, possibly present at birthStiffness of neck musclesPainful spasms of neck and upper back musclesLimited range of motion of the head and neckHeadache Muscles of the Neck 2008 Nucleus Medical Art, Inc. 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. DiagnosisThe doctor will ask about your symptoms and medical history, and perform a physical exam.Tests may include:X-rays of the necka test that uses radiation to take a picture of structures inside the body CT scan of the necka type of x-ray that uses a computer to make pictures of structures inside the body MRI scan of the necka test that uses magnetic waves to make pictures of structures inside the body TreatmentThe 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:
Congenital TorticollisPositioning of the infant to avoid sleeping on one sidePositioning of toys to encourage turning of the headStretching exercises several times each dayIn some situations, surgery to cut the muscle that causes torticollis Acquired TorticollisIdentifying the causePhysical therapy to help relax the muscle and reduce painIn some situations, surgery to cut the nerve to the muscle that is in spasm Oral medications: 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) Injections Injection of botulinum toxin may 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.Another treatment involves injection of alcohol or phenol to deaden the nerve that causes the muscle contraction.Each of these treatment options has various risks and benefits and it is important to work with your doctor to find the right treatment for you.
PreventionThere are no guidelines for preventing torticollis. Early treatment may help keep the symptoms from worsening. RESOURCES: The American Speech Language Hearing Association (ASHA)http://www.asha.org Dystonia Medical Research Foundationhttp://www.dystonia-foundation.org National Spasmodic Torticollis Associationhttp://www.torticollis.org WE MOVE: Worldwide Education and Awareness for Movement Disordershttp://www.wemove.org CANADIAN RESOURCES: BC HealthGuidehttp://www.bchealthguide.org Canadian Family Physicianhttp://www.cfpc.ca/cfp/ References: Collins A, Jankovic J. Botulinum toxin injection for congenital muscular torticollis presenting in children and adults. Neurology . 2006 Sep 26;67(6):1083-5. 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 Nov;95(11):1509-10. Herman MJ. Torticollis in infants and children: common and unusual causes. Instr Course Lect . 2006;55:647-653. The Merck Manual Diagnosis and Therapy . 17th ed. Merck & Co; 1999. 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/ . Last reviewed October 2007 by Rimas Lukas, MDPlease 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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