Dystonia, cervical (CD)

• Focal dystonia
• Dystonia
• Spasmodic torticollis
• Anterocollis
• Retrocollois
• Laterocollis

• 333.83 Spasmodic torticollis

• G24.3 Spasmodic torticollis

• 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation

Description

• Dystonia is a condition that is characterized by involuntary intermittent or prolonged muscular contractions, such as twisting or repetitive movements, which may cause abnormal postures and movements
• Dystonia may be generalized or focal
• Cervical dystonia (CD) is the most common focal dystonia
• Cervical dystonia is commonly referred to as spasmodic torticollis, which may be misleading
  • Spasmodic describes movements that are intermittent or clonic and tremulous, though some patients with CD present with prolonged contractions
  • Torticollis implies rotary impairment, though patients with CD often present with combined postures associated with flexion, extension, and side-bending
• Further classification may be based upon head position or movement2
  • Forward is called anterocollis
  • Backward is called retrocollois
  • Left or right is called laterocollis
  • Moving from side to side is called rotational spasmodic torticollis
  • Turning and shaking of the head is called mixed torticollis

Essentials of Diagnosis

• Traditional classification is based upon etiology
  • Primary (idiopathic)
  • Secondary (of known cause)
• Current classification describes each person based upon the following characteristics
  • Age of onset
  • Distribution of symptoms

General Considerations

• Most cases develop in adulthood
• A similar musculoskeletal condition during infancy is called congenital muscular torticollis
• Patients with CD can show signs of self-consciousness and depression

Demographics

• Incidence of cervical dystonia is 8.9 per 100,000 people
• Occurrence in men to women ranges from 1 man to 1.4 to 2.2 women (1:1.4 to 2.2)
• Mean onset of age is 39.2 years for men and 42.9 years for women1
• Approximately 90% of cases are idiopathic and 10% to 20% are from a defined cause

Signs and Symptoms

• Common to patients with primary and secondary CD
  • Pain
  • Enlargement of the neck muscles
  • Shoulder elevation on affected side
  • Ipsilateral head tilt and contralateral head rotation
  • Head tremor or spasmotic jerking
  • Tremors of the arm
  • Possible difficulty swallowing
• Unique to patients with post-traumatic CD
  • Marked limitation in range of motion
  • Lack of improvement after sleep
  • Lack of Geste antagoniste, also known as sensory tricks, are physical positioning, such as touching the chin, which have been shown to temporarily reduce dystonia5

Functional Implications

• Postural control abnormalities
• Greater reliance on vision for maintaining postural stability1
• Reduced ability to perform activities of daily living involving head or neck movements
• Difficulty sleeping
• Reduced psychosocial functioning

Possible Contributing Causes

• Primary cervical dystonia
  • Idiopathic cause
• Secondary cervical dystonia
  • Drugs
    • Neuroleptics
    • Dopamine agonists
    • Anticonvulsants
    • Antimalarial drugs
  • Environmental toxins
    • Manganese
    • Carbon monoxide
    • Methanol
  • CNS lesions
    • Intramedullary lesions of the cervical cord
    • Focal ...