Torticaput versus Torticollis: Clinical Effects with Modified Classification and Muscle Selection

Wolfgang H Jost

doi:10.5334/tohm.474

Abstract

Background: Several different subtypes are distinguished in cervical dystonia, depending on their different levels of movement. In simple rotation, classified as torticollis spasmodicus, we now differentiate between torticollis and torticaput dependent on whether only the head or the neck is turned. The new classification system permits for different injection schemes. Case reports: In a retrospective study of 22 patients, we examined whether modifying the injected muscles leads to improvement in the results as evaluated in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). The results showed that both injection schemes do in fact lead to improvements while differentiating between caput and collum has significantly better effects. Discussion: Due to our results we recommend the classification differentiating between torticollis and torticaput type.

Highlights

Patients and methodsIn the last few years, a distinction has been made in cases of cervical dystonia between the so-called head and neck types, for example, between torticaput and torticollis.[1,2] Relying on this classification, different muscles have been injected from what was previously the case
Due to our results we recommend the classification differentiating between torticollis and torticaput type
That is why we asked if there is any advantage of the classification differentiating torticaput and torticollis (Figure 2), the consequent change in injection scheme, and the selection of different muscles

Summary

Discussion

Since Reichel’s publication in 2011 we have been discussing different subtypes of cervical dystonia.[2]. The muscles traditionally injected in cases of torticollis are the contralateral sternocleidomastoideus and the ipsilateral splenius capitis[5] whereby it is important to note that the contralateral sternocleidomastoideus has an effect on head rotation and not that of the neck.[1,2]. Selection of muscles for botulinum toxin injections in cervical dystonia. 6. Jost WH, Schramm A, Müngersdorf M, Stenner A, Schwingenschuh P, Maisonobe P, et al Effectiveness of botulinum neurotoxin type A injections in naïve and previously-treated patients suffering from torti- or laterocollis or. A new botulinum toxin type A free of complexing proteins for treatment of cervical dystonia. Rating scales for cervical dystonia: a critical evaluation of tools for outcome assessment of botulinum toxin therapy. The subjective improvements and the quality of life should be recorded

Patients and methods

Results