[Cervical dystonia--diagnosis and treatment]

Cervical dystonia is a focal dystonia of the neck muscles, leading to involuntary head movement, abnormal postures and pain. As effective treatment is available, all doctors should be able to recognize this potentially disabling disorder.

The manuscript is based on literature retrieved from searches in Medline databases, and the author's own clinical experience and research.

Diagnosis is based on identification of typical symptoms and signs. Cervical dystonia is most often primary, with unknown cause, but can also be secondary to other neurological disease. Dystonic movements are typically spasmodic and repeated in a stereotype pattern. From onset they are often mild and intermittent, but become constant with progression. Turning of the head (torticollis) is most frequent, but lateroflexion (latero-), extension (retro-) and flexion (anterocollis) of the neck are also seen. The range of voluntary neck movement is often reduced. Botulinum toxin injected into the affected neck muscles has proven to be efficient and safe, and is the treatment of choice. Studies show that the majority of patients have a good efficacy and health-related quality of life also in the long-term. The minority of patients with unsatisfactory treatment response should be evaluated for pallidal deep brain stimulation.