Retrocollis: Classification, Clinical Phenotype, Treatment Outcomes and Risk Factors

Abstract

Retrocollis (RC) is a form of cervical dystonia (CD) that produces patterned, repetitive muscle contractions that result in neck extension. We performed a review of consecutive CD patients seen in our Division over a 15-year period. Out of 399 CD patients, 59 (14.8%) had features of RC. Pain was very frequently reported among patients (∼80%). RC was frequently associated with neuroleptic exposure (20.3%) and a history of head/neck trauma (23.7%). Of patients injected with botulinum toxin type A, 24.5% reported excellent, 32.1% moderate, 16.9% mild and 24.5% no response to injections. Oral antidystonic medications had limited contribution to symptom relief.

Comanagement and Collaborative Care of a 20-Year-Old Female With Acute Viral Torticollis

“…In essence, cervical dystonia is a neurological condition thought to originate in the basal ganglia portion of the brain. 19 An imbalance of a neurotransmitter such as acetylcholine may be responsible for the condition. This neurotransmitter is secreted from the basal ganglia and induces nerve stimulation of certain muscles of the neck.…”

“…The increased nerve stimulation of the cervical musculature causes spasms to occur, which produces various antalgic postures of the neck. 19 The antalgic posture characterizing spasmodic torticollis usually includes 1 of 4 presentations. Retrocollis is a form of cervical dystonia that produces patterned, repetitive muscle contractions that result in neck extension.…”

“…This presentation is frequently associated with neuroleptic exposure and a history of head and neck trauma. 19 Anterocollis presents with a forward flexion posture of the head and neck and may be associated with a focal myopathy. 20 Rotational collis presents with an upright posture of the head, which is rotated to either the left or right side of the body, in contrast to laterocollis, in which the head is laterally flexed toward either shoulder.…”

Botulinum Toxin Treatment of Cervical Dystonia

“…Retrocollis may be secondary to tardive mechanisms and other neurodegenerative processes such as progressive supranuclear palsy. Some authors have suggested that these associations have led to exclusion of subjects with retrocollis from clinical trials, 52 whereas others have pointed to concern over potential neck extensor weakness secondary to injections. One study evaluating a cohort of CD patients with retrocollis identified this subtype in 59 (14.8%) of 399 CD patients evaluated over a 15-year period.…”

What’s new in dystonia?

“…A chart review of 59 patients with late-onset retrocollis found that only 20.3% of patients had a history of exposure to dopamine blockers [25]. Neuroleptic exposure was signifi cantly higher in a retrocollis-predominant population than retrocollis-nonpredominant cases (28.2% vs 5%; P = 0.03).…”