[Therapeutic possibilities in spasmodic torticollis]

Spasmodic torticollis is classified as a focal dystonia. It is characterized by involuntary contractions of the muscles of the neck, with consequent deviation of the head from the correct posture. Psychological factors are recognized as important trigger and aggravating mechanisms. The various possibilities of therapeutic management (medical and surgical treatment, psychological methods and psychotherapy) are reviewed. Therapy of spasmodic torticollis should be started with methods such as biofeedback, behaviour therapy, and anticholinergic drugs. If these procedures not successful, local application of botulinum toxin offers a new and highly effective technique. Surgical treatment such as neurotomy, rhizotomy, or stereotaxic operations should be restricted to otherwise intractable cases.