DystoniaDystonia is an organic neurological movement disorder. It can occur at any age. Anyone can be affected. About 80.000 people in Germany suffer from it, including 15.000 children and teenagers. It originates in the so-called movement centers in the brain. Their manifestations are manifold. Characteristic are involuntary cramps of muscles. This triggers unusual body postures and movements, which can manifest themselves in different parts of the body.
Among the dystonias:
Torticollis (Torticollis spasmodicus)
Torticollis translates as "twisted neck". The epithet "spasmodicus" is meant to express that in many cases the head is not only twisted, but can often be accompanied by a restlessness of movement (head wobbling or head trembling) – at least during certain head movements.
The disorder is characterized by a slow rotation of the head around a vertical axis to one side, usually combined with a slight tilt of the head and is classified as a focal dystonia. In other cases, there is a forward or backward tilt of the entire neck. Occasionally, the movement pattern is also jerky, sometimes resulting in tremor, which is referred to as yes-yes, no-no or yes-no tremor, depending on the movement pattern. The muscles responsible for movement thicken (hypertrophy).
In Germany, according to one study, about nine inhabitants of every 100.000 affected by this disease. It is estimated that the actual incidence is two to three times as high. The disease usually appears around the age of 40. It can develop very quickly ("overnight") or slowly over a period of several months. Often neck tensions or head trembling are initial symptoms even before the misalignment of the head is noticed. In addition to the malposition, many patients also complain of severe pain.
A distinction is made in torticollis according to the three main directions of movement of the head:
Rotational Torticollis: rotation around a vertical axis Laterocollis: lateral tilt on the shoulder Retro-/Anterocollis: Tilt forward or backward
The most common form is rotatory torticollis, followed by combinations of torticollis and laterocollis.
According to the latest findings of Prof. Reichel (Zwickau), torticollis can be differentiated even further. If the dystonic deformity occurs further up, i.e. only in the joint between the occiput of the skull and the atlas (1. cervical vertebrae), the so-called. atlantoaxial joint is localized then one speaks of torticaput, laterocaput or. Retro- and Anterocaput.
The cause for the development of cervical dystonia is not yet clear. A disorder in the area of the extrapyramidal system (basal ganglia) is suspected.
In some patients, in whom a striking familial cluster of cases has been observed, there are indications of a genetic cause.
The decisive factor for the diagnosis of torticollis is the recognition of the typical movement patterns. Additional neurological symptoms such as paralysis, uncoordinated movements, attention and memory disorders indicate a different disease. In only about five percent of patients, torticollis is a secondary symptom of another disease.
Less than half of all patients with cervical dystonia benefit from drug therapy (especially with anitcholinergics). This is also associated with significant systemic side effects. For this reason, therapy with botulinum toxin is now considered the treatment of choice for this indication.
According to the literature, a satisfactory result (this includes not only improvement of the malposition but also pain relief) is reported in 60 to 90%. Patients with a shorter course benefit more from therapy with botulinum toxin than patients with a longer-standing condition.
Patients can also find help and further information at torticollis self-help groups