Torticollis (Cervical Dystonia - Twisted Neck)

Abnormal turning, tilting, or bending of the head due to involuntary contraction of the neck muscles.

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Movement Disorders

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1Overview

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What is this Condition?

Torticollis (cervical dystonia) is an abnormal head position resulting from involuntary and sustained contraction of the neck muscles; the head may turn to one side, tilt laterally, or bend forward or backward. It is the most common form of focal dystonia seen in adults and typically begins in middle age. Symptoms usually progress slowly and are frequently accompanied by neck pain. In many patients, light touch to the chin or cheek temporarily corrects the head position; this finding is a clue to diagnosis. Although torticollis is not a dangerous disease, the pain, appearance, and impacts on daily activities can be bothersome. Effective treatment options are available. (This page describes adult cervical dystonia, different from congenital torticollis in infants caused by muscle shortening.)

Symptoms

Involuntary turning of the head to one side, lateral tilting, or forward-backward bending

Persistent or intermittent sensation of neck muscle contraction

Neck and head pain

Mild tremor in the head

Temporary correction of head position with light touch to chin/cheek

Worsening with stress, improvement with rest and sleep; anxiety related to appearance

Diagnosis Methods

Diagnosis is typically made based on history and physical examination; the abnormal head position, contraction pattern, and temporary improvement with touch are assessed. Neck and brain MRI may be requested to exclude other underlying causes. In young patients, blood and urine tests may be performed to exclude disorders related to copper metabolism; electromyography (EMG) can help identify target muscles for injection therapy.

Treatment Methods

First-line and most effective treatment is botulinum toxin (botox) injections applied to the contracted neck muscles; the effect lasts for several months and is repeated at regular intervals, reducing pain and postural abnormality. Some oral medications can be used as supportive treatment. Physical therapy, exercises, and sensory trick training are helpful. In selected patients who do not respond adequately to pharmacological treatments and whose daily life is severely affected, deep brain stimulation (DBS) surgery can be considered.

Botulinum toxin (botox) injections (typically every 3-4 months)

Oral supportive medications (muscle relaxants, etc.)

Physical therapy, exercises, and sensory trick training

Deep brain stimulation (DBS) surgery in resistant cases

Treatment Path

Related Treatments

The procedures and interventions most commonly explored with this condition.

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DBS implantasyonu, tek taraflı

DBS implantasyonu, tek taraflı procedure

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DBS implantasyonu, iki taraflı

DBS implantasyonu, iki taraflı procedure

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DBS implantasyonu, mikroelektrod kayıt eşliğinde

DBS implantasyonu, mikroelektrod kayıt eşliğinde procedure

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Baklofen pompası implantasyonu

Baklofen pompası implantasyonu procedure

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References

Krauss JK. Selective Peripheral Denervation for Cervical Dystonia. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 6th ed. Elsevier; 2011.
Greenberg MS. Handbook of Neurosurgery. 10th ed. Thieme; 2023.
Stereotactic and Functional Neurosurgery. Cham: Springer; 2020.

This content is for informational purposes and based on academic sources; consult your physician for diagnosis and treatment.

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Torticollis (Cervical Dystonia - Twisted Neck)

Movement Disorders

1Overview

What is this Condition?

Symptoms

Diagnosis Methods

Treatment Methods

Related Treatments

DBS implantasyonu, tek taraflı

DBS implantasyonu, iki taraflı

DBS implantasyonu, mikroelektrod kayıt eşliğinde

Baklofen pompası implantasyonu

References

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DBS implantasyonu, tek taraflı

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