torticollis


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Torticollis

 

Definition

Torticollis (cervical dystonia or spasmodic torticollis) is a type of movement disorder in which the muscles controlling the neck cause sustained twisting or frequent jerking.

Description

In torticollis, certain muscles controlling the neck undergo repetitive or sustained contraction, causing the neck to jerk or twist to the side. Cervical dystonia causes forward twisting, and is called antecollis. Backward twisting is known as retrocollis. The abnormal posture caused by torticollis is often debilitating, and is usually painful.
Torticollis most commonly begins between age 30-60, with females affected twice as often as males. According to the National Spasmodic Torticollis Association, torticollis affects 83,000 people in the United States. Dystonia tends to become more severe during the first months or years after onset, and may spread to other regions, especially the jaw, arm, or leg. Torticollis should not be confused with such other causes of abnormal neck posture as orthopedic or congenital problems.

Causes and symptoms

The nerve signals responsible for torticollis are thought to originate in the basal ganglia, a group of brain structures involved in movement control. The exact defect is unknown. Some cases of dystonia are due to the inheritance of a defective gene, whose function was unknown as of mid-1998. Other cases are correlated with neck or head trauma, such as from an automobile accident. Use of certain antipsychotic drugs, or neuroleptics, can induce dystonia.
There are three types of torticollis:
  • tonic, in which the abnormal posture is sustained
  • clonic, marked by jerky head movements.
  • mixed, a combination of tonic and clonic movements
Symptoms usually begin gradually, and may be intermittent at first, worsening in times of stress. Symptoms usually progress over two to five years, and then remain steady. Symptoms may be relieved somewhat when lying down. Many people with torticollis can temporarily correct their head position by sensory tricks, as touching the chin or cheek on the side opposite the turning. The reason for the effectiveness of this "geste antagoniste," as it is called, is unknown.
Pain in the neck, back, or shoulder affects more than two-thirds of all people with torticollis. Pain may spread to the arm or hand.

Diagnosis

Diagnosis of torticollis is aided by an electrical study (electromyography) that can detect overactive muscles. Imaging studies, including x rays, may be done to rule out other causes of abnormal posture. A detailed medical history is needed to determine possible causes, including trauma.

Treatment

A variety of oral drugs are available to relax muscles, including baclofen. For a subgroup of patients, L-dopa provides effective relief. Denervation of the involved neck muscles may be performed with injection of alcohol or phenol on to the nerve.
Injection of botulinum toxin (BTX) is considered by many to be the treatment of choice. By preventing release of chemical messages from the nerve endings that stimulate the involved muscles, BTX partially paralyzes the muscles, therefore allowing more normal posture and range of motion. BTX treatment lasts several months, and may be repeated.
Physical therapy can help relieve secondary consequences of torticollis. Regular muscle stretching prevents contracture, or permanent muscle shortening. Pain and spasm may be temporarily lessened with application of heat or ice. Stress management techniques may help prevent worsening. An occupational therapist can suggest home or work modifications to reduce fatigue and improve function. Braces constructed to replace the patient's own sensory tricks may help reduce abnormal posture.

Alternative treatment

Biofeedback may be effective for some patients. Regular massage therapy can reduce additional pain in compensating areas of the body. Two energy-based therapies, acupuncture and homeopathic medicine, can work to rebalance the whole person, helping to correct the torticollis. Antispasmodic herbs may help to relax the muscles. In addition, herbs that can help balance the stimulus from the nervous system are often recommended.

Prognosis

Spontaneous remission is seen in up to 20% of patients, most often those patients with older onset and milder symptoms. Dystonia may spread to affect other regions of the body.

Prevention

There is no way known to prevent torticollis.

Resources

Organizations

National Spasmodic Torticollis Association. P.O. Box 5849, Orange, CA 92863-5849. (800) 487-8385. http://www.bluheronweb.com.
Worldwide Education and Awareness for Movement Disorders. One Gustave L. Levy Place, Box 1052, New York, NY 10029. (800) 437-6683. http://www.wemove.org.

torticollis

 [tor″tĭ-kol´is]
a contracted state of the cervical muscles, producing torsion of the neck; the deformity may be congenital, hysterical, or secondary to conditions such as pressure on the accessory nerve, inflammation of glands in the neck, or muscle spasm. Called also wryneck.
Torticollis. From Dorland's, 2000.

tor·ti·col·lis

(tōr'ti-kol'is), [MIM*189600]
A contraction, or shortening, of the muscles of the neck, chiefly those supplied by the accessory nerve (NXI); the head is drawn to one side and usually rotated so that the chin points to the other side.
See also: dystonia.
Synonym(s): wry neck, wryneck
[L. tortus, twisted, + collum, neck]

torticollis

(tôr′tĭ-kŏl′ĭs)
n.
A contracted state of the neck muscles that causes the neck to rotate and tilt sideways, forwards, or backwards. Also called wryneck.
A focal dystonia consisting of one-sided contracture with palpable induration of the sternocleidomastoid muscle, causing the chin to turn towards the opposite side and the head to rotate towards the lesion; wryneck is accompanied by facial muscle dysplasia
Aetiology Congenital form—unclear—possibly due to in utero or peripartum trauma to venous drainage, causing asymmetric development of the face and skull; the later it is recognised, the more likely it will require surgery

torticollis

1. Congenital torticollis.
2. Torticollis Loxia, spasmodic torticollis, wryneck Neurology The most common of the focal dystonias, in which the neck muscles cause the head to twist to one side, and possibly be shifted forward or backward, often linked to prolonged muscle contractions Etiology Idiopathic, congenital, acquired due to neuromuscular damage; congenital torticollis may be caused by malpositioning of head in uterus or by prenatal injury of muscles or blood supply in neck. See Febrile torticollis.

tor·ti·col·lis

(tōr'ti-kol'is)
A contraction, often spasmodic, of the muscles of the neck, chiefly those supplied by the spinal accessory nerve; the head is drawn to one side and usually rotated so that the chin points to the other side.
Synonym(s): wryneck, wry neck.
[L. tortus, twisted, + collum, neck]

torticollis

A permanent, intermittent or spasmodic twisting of the head or neck to one side. Causes of torticollis include birth injury to one of the long neck muscles, scarring and shortening of the neck skin, spasm of the neck muscles, WHIPLASH INJURY, TICS and vertical imbalance of the eye muscles. Treatment depends on the cause. Also known as wry neck.

Cruchet,

Jean R., French physician.
Cruchet disease - Synonym(s): torticollis

tor·ti·col·lis

(tōr'ti-kol'is) [MIM*189600]
Contraction, or shortening, of muscles of neck, chiefly those supplied by the accessory nerve (CN XI).
[L. tortus, twisted, + collum, neck]
References in periodicals archive ?
Role of the vestibular system in the pathophysiology of spasmodic torticollis. J Neurol Neurosurg Psychiatry.
Two-thirds of them also experienced flat spots on their heads called plagiocephaly, which commonly occurs in babies with torticollis and is related to spending too much time lying down in one position.
Caption: Figure 1: Patient showing torticollis before treatment, with head tilting, neck rotation, and a characteristic "cock-robin" position (a).
Our patient was brought to medical attention due to his torticollis. While the exact reason for the torticollis is unclear, we feel it is important to raise the awareness of this rare manifestation of Kawasaki disease.
Ocular plagiocephaly: ocular torticollis with skull and facial asymmetry.
Benign paroxysmal torticollis is a movement disorder characterized by recurrent episodes with an onset at the age of 2-8 months in infancy.
Deep brain stimulation for generalized dystonia and spasmodic torticollis. J Clin Neurosci 2005; 12: 12-16.
The role of congenital muscular torticollis in the development of deformational plagiocephaly.
Sprengel deformity is often associated with one of the following conditions: Klippel-Feil syndrome, spina bifida, kyphoscoliosis, torticollis, etc.
A physical examination showed increased tone in all muscles of the neck and a dystonic posture with torticollis to the left side (video).
[10] This can allow the patient with focal types of dystonia, such as musician's cramp or cervical torticollis, to have normalised movements of their hands or neck, depending on the pathology and the selected injection sites.
Answer: What you are seeing in your rabbit is something called a head tilt (also known as torticollis or wry neck).