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Condition
Spasmodic Torticollis

Involuntary movement of the neck muscles, twisting, tilting or pulling the head backward or forward, defines spasmodic torticollis. Pain in the side or the back of the neck and sometimes head tremor increase the distress of the patient. Spasmodic torticollis is a focal dystonia (like blepharospam and writer’s cramp), and is also called cervical dystonia.

Treatment

Since 1986, Botulinum toxin injections have been shown to be the most efficient treatment of cervical dystonia. The choice of the muscles to inject and the dose depend on the type of torticollis and need to be customised for every patient after a careful clinical examination.

Physiotherapy, in addition to the Botulinum toxin injections, helps the patient to improve the control of head posture. In very rare and severe cases, surgical treatment can be discussed with the patient.

The injections are performed with the patient sitting down. The toxin’s effect occurs 7 to 15 days after the injections, which are performed every 4 months in average, though the interval between injections can be longer, depending on the patient’s response. The main side effect is dysphagia (difficulty swallowing) in less than 10 % of the cases; it can last 2 to 4 weeks and means that the patient has to be more cautious when eating.



Sterno-cleido-mastoid muscle (SCM)
Mainly responsible of rotation of the head to the opposite side (right SCM turns the head to the left)



Splenius : its main action is to turn the head towards the same side. The right splenius turns the head to the right. If the right and left splenius acts together, the head goes backward in extension.



The right trapezius elevates the right shoulder and turns the head to the left (opposite side).




Right Levator scapulae elevates the right shoulder and turns the head to the right (ipsilateral side)

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Expression Lines
Right laterocollis

Retrocollis

Torticollis
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