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5 - Treatment of cervical dystonia

Published online by Cambridge University Press:  28 July 2009

By
Reiner Benecke ,
Karen Frei  and
Cynthia L. Comella
Edited by
Daniel Truong ,
Dirk Dressler  and
Mark Hallett
Daniel Truong
Affiliation:
Orange Coast Memorial Medical Center
Dirk Dressler
Affiliation:
Hannover Medical School, Hannover, Germany
Mark Hallett
Affiliation:
George Washington University School of Medicine and Health Sciences, Washington, DC
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Summary

Introduction

Cervical dystonia (CD), originally known as spasmodic torticollis and first described by Foltz in 1959, is a neurological syndrome characterized by abnormal head and neck posture due to tonic involuntary contractions in a set of cervical muscles (Foltz et al., 1959). Myoclonic or tremulous movements are often superimposed in CD, producing a “tremor like” appearance – especially early in the disease state. The terms CD and spasmodic torticollis are not interchangeable: CD is the preferred term when referring to idiopathic focal dystonia of the neck. Spasmodic torticollis is now considered to be one of four types of CD. Cervical dystonia is classified into four types based on the principal direction of head posture: torticollis (abnormal rotation of the head to the right or to the left in the transverse plane); laterocollis (the head tilts toward the right or left shoulder); anterocollis (the head pulls forward with neck flexion); and retrocollis (the head pulls back with the neck hyperextended).

Cervical dystonia is slightly more common in females, with a male to female ratio of 1:1.2 (Kessler et al., 1999). Onset is usually insidious, although in some patients the onset has been reported as sudden. Cervical dystonia may develop in patients of all age groups, but the peak age of onset is 41 years (Kessler et al., 1999). Idiopathic CD usually progresses in severity over the first five years until it reaches a plateau, during which time the CD remains fairly constant and becomes a lifelong condition.

Type
Chapter
Information
Manual of Botulinum Toxin Therapy , pp. 29 - 42
Publisher: Cambridge University Press
Print publication year: 2009

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References

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