Prevalence

• Primary CD is the most common form of adult-onset focal dystonia.

• Prevalence of six to nine per 100,000 population.

• The peak age at onset is between 40 and 45 years.

• Females are more commonly affected than males (male-to-female ratio 1.4:2.2)

Cervical Dystonia

Diagnosis & Classification

Time to Diagnosis

Cervical Dystonia

Anatomy

• Journal Neurological Sciences - 2015
  108 patients

  • Less than 10 years - mean time 2.2 yrs

  • Greater than 10 years - mean time 4 yrs

• Journal of Neurology 2015
  1017 patients

  • The mean time since diagnosis was 9.6 years

  • Over half (54%) of patients surveyed were not diagnosed in the first year

Symptoms & Time to Diagnosis

Cervical Dystonia

Anatomy

• 66% of patients reported being misdiagnosed. 

• The most frequent misdiagnoses were:

  • Psychological illness or stress disorder (37%)

  • Cervical muscle strain (23%)

  • Tremor (15%)

Cervical Dystonia

Anatomy

Symptoms & Time to Diagnosis

Cervical Dystonia

Anatomy

Symptoms & Time to Diagnosis

• Pain, which is often described as ‘aching’ or ‘pulling’ and occurs in 70–75% of patients.

• The maximum pain is usually felt in the muscles ipsilateral to the side of the chin deviation.

Classification

Cervical Dystonia

Anatomy

Evaluation of Cervical Dystonia in terms of:

• Postural deviation in the axial plane (torticollis)

• Coronal plane (laterocollis)

Classification

Cervical Dystonia

Anatomy

• Saggital plane (anterocollis and retrocollis)

• Most patients with cervical dystonia have postural deviation in at least two of these planes.

• In addition, the presence of shoulder elevation and of saggital and lateral shift are important elements to note.

Abnormal Head Postures

Cervical Dystonia

Anatomy

Frequency

Caput-Collis Concept

Cervical Dystonia

Anatomy

Torticollis/caput

Cervical Dystonia

Anatomy

Head rotated via C1-2 (Atlanto-axial joint)

C3-7 vertebral column no movement

Torticaput

C3-6 rotate with C1-2 and head

Torticollis

Retrocollis/caput

Cervical Dystonia

Anatomy

Head extended past 15 degrees

Head extended less than 15 degrees

Laterocollis/caput

Cervical Dystonia

Anatomy

Missing Video - Big Upload

Laterocaput

Laterocollis

Larynx shifted relative to sternum

Anterocaput/collis

Cervical Dystonia

Anatomy

Anterocaput

Anterocollis

Missing Video - Big Upload

Combination of Postures

Cervical Dystonia

Anatomy

Most common rotation and tilt -30%.

Rotation tilt flexion or extension 20%

Lateral Shift

Cervical Dystonia

Anatomy

Secondary to lateral flexion of the spine and flexion of the head in the opposite direction

Saggital Shift

Cervical Dystonia

Anatomy

Due to a combination of extension of head and flexion of neck.

Missing Video - Big Upload

Due to a combination of neck extension and head flexion.
Produces “double chin” look.

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