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6 - Cervical dystonia

Published online by Cambridge University Press:  02 December 2009

By
Khalid Anwar
Edited by
Anthony B. Ward  and
Michael P. Barnes
Khalid Anwar
Affiliation:
Hunters Moor Regional Neurological Rehabilitation Centre, Newcastle upon Tyne, UK
Anthony B. Ward
Affiliation:
University Hospital of North Staffordshire
Michael P. Barnes
Affiliation:
Hunters Moor Regional Neurological Rehabilitation Centre
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Summary

Introduction

The term dystonia is defined as a sustained, involuntary contraction of muscle that produces an abnormal posture and frequently causes twisting and turning. Cervical dystonia is the most common form of adult-onset focal dystonia. It is defined as involuntary twisting and turning of the neck caused by abnormal involuntary muscle contractions. This abnormal posture may be associated with spasms, jerks or tremors or a combination of these features. Cervical dystonia also has been referred to as spasmodic torticollis but this term does not reflect the dystonic nature of the problem. It implies that spasms are an essential feature of the disease although these can be absent in 25–30 per cent of the patients with cervical dystonia. Torticollis on the other hand is the physical sign of the twisted neck and may result from many non-dystonic causes.

It is well known that due to variable presentation of this disease cervical dystonia is frequently misdiagnosed and accurate diagnosis is often delayed. The aetiology and pathogenesis of cervical dystonia remains unclear. However it is generally agreed that genetic factors, trauma, altered sensory input, primary vestibular abnormality and impaired basal ganglia function may all have some role in the development of this disease. Adult-onset cervical dystonia usually does not become generalized although there may be segmental spread with involvement of arms jaws or trunk. A small percentage of patients can have a spontaneous remission but it is usually short lived and incomplete.

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Clinical Uses of Botulinum Toxins , pp. 80 - 110
Publisher: Cambridge University Press
Print publication year: 2007

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