DIAGNOSIS AND CLASSIFICATION OF CERVICAL DYSTONIA
Professor Con Yiannikas
Prevalence
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Primary CD is the most common form of adult-onset focal dystonia.
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Prevalence of six to nine per 100,000 population.
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The peak age at onset is between 40 and 45 years.
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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
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Journal Neurological Sciences - 2015
108 patients-
Less than 10 years - mean time 2.2 yrs
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Greater than 10 years - mean time 4 yrs
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Journal of Neurology 2015
1017 patients-
The mean time since diagnosis was 9.6 years
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Over half (54%) of patients surveyed were not diagnosed in the first year
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Symptoms & Time to Diagnosis
Cervical Dystonia
Anatomy
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66% of patients reported being misdiagnosed.
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The most frequent misdiagnoses were:
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Psychological illness or stress disorder (37%)
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Cervical muscle strain (23%)
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Tremor (15%)
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Cervical Dystonia
Anatomy
Symptoms & Time to Diagnosis
Cervical Dystonia
Anatomy
Symptoms & Time to Diagnosis
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Pain, which is often described as ‘aching’ or ‘pulling’ and occurs in 70–75% of patients.
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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:
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Postural deviation in the axial plane (torticollis)
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Coronal plane (laterocollis)
Classification
Cervical Dystonia
Anatomy
- Saggital plane (anterocollis and retrocollis)
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Most patients with cervical dystonia have postural deviation in at least two of these planes.
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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.