Torticollis is most commonly observed, in mid-adult life with an incidence being between 30 to 40 years of age. Initially torticollis begins with a feel of tension in the neck muscles for months before the manifestation of dystonia. This is followed by intermittent posturing of the neck with head turning. Over a period of time this becomes constant and fixed, only abating during sleep. Symptoms may progress rapidly over several weeks or gradually over several years until a plateau is typically reached 3 to 5 years after the initial manifestation. Though temporary, spontaneous remission of torticollis has been known. Permanent remission is almost unusual.
Spasmodic Torticollis is an adult onset focal or segmental dystonia with a variable combination of neck flexion, extension, rotation and tilting. Each patient has a characteristic dystonic posturing. This dystonic posture is present at rest, worsen with action or stress and improve or resolve completely during sleep.
Rotational torticollis– there is a rotation of the chin towards the shoulder.
Laterocollis– It is a lateral tilt of the head in the coronal plane with the ear moving toward the shoulder.
Anterocollis– It is a forward deviation of the head in the sagittal plane with the chin moving towards the chest.
Retrocollis– It is the backward deviation of the head in the sagittal plane thereby elevating the chin and moving the occiput towards the upper back.