Objective: The aim of our study was to classify patients with idiopathic cervical dystonia who had never been injected botulinum toxin.

Background: Idiopathic cervical dystonia is the most common form of adult-onset focal dystonia. Traditionally it has been classified as torticollis, laterocollis, retrocollis, and anterocollis. Many patients have a combination of these movements creating diagnostic uncertainty in a clinical setting.

Method: This was a prospective study of 45 patients of idiopathic cervical dystonia who had never been injected with botulinum toxin, carried out at our tertiary care center. The patients were studied for the type of cervical dystonia and associated symptoms.

Results: We evaluated 45 patients of cervical dystonia with male: female ratio of 3:2 and a mean age of presentation of 45.08 ±12.74 years (range 22 – 65 years). The median duration of symptoms was 4 years. Torticollis was found in 35 patients, laterocollis in 18, anterocollis in 4, retrocollis in 16, Lateral shift in 5 and sagittal shift in 9 patients. Out of the 9 patients with sagittal shift, seven had anterior saggital shift (goose neck) while two had posterior sagittal shift (double chin). Thus, only 12 (26.66%) patients had a single type of cervical dystonia while rest of the 33 (73.33%) patients had at least two different forms of cervical dystonia. Thus, majority of the patients did not follow the paradigm of conventional dystonia classification into the four basic subtypes (Torticollis, laterocollis, retrocollis and anterocollis).

Conclusion: The traditional classification of classifying cervical dystonia into four major subtypes (torticollis, laterocollis, retrocollis and anterocollis) was not helpful in majority of our patients as only 26.66% of patients had fallen into one of the categories. The collis-caput concept may be a more practical semiological analysis procedure for cervical dystonia, which is mainly build on anatomic data and muscle function (1,2). There is a need for doing observational studies classifying cervical dystonia based on collis-caput concept, which may be more practical and helpful to know the frequency of various subtypes in the clinical setting. The abstract was presented at the Movement disorders society of India conference 2019 (MDSICON 2019).

References: 1) Reichel G (2011) Cervical dystonia: a new phenomenological classification for botulinum toxin therapy. Basal Ganglia 1:5–12. 2) Pandey S, Singh AS. The double-chin posture: Posterior sagittal shift in cervical dystonia. Neurol India 2016;64:556-8

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MDS Abstracts - https://www.mdsabstracts.org/abstract/classification-of-idiopathic-cervical-dystonia-an-observational-study/