- Neck and shoulder pain – It is prominent in 75% of patients. Pain is much more common in cervical dystonia than in other adult-onset focal dystonia. It is typically located in the posterior cervical region on the same side of the direction of head rotation or head tilt.
- Sensory tricks- Once dystonic postures develop, most patients are able to identify the provocating and relieving factors. It is also called as ‘‘Geste Antagoniste’’ or ‘‘Gegendruck phenomen’’ e.g. touching the face and holding the back of the head, holding the chin, leaning the head against the chair, holding or pulling the hair etc. It is a characteristic and unique feature as well as its presence is a diagnostic clue to this condition. It is known to temporarily reduce or even abolish dystonic posturing.
Other Clinical Features in Idiopathic Cervical Dystonia
- upper limb and/or head tremor
- jaw (oromandibular)
- eyelids (blepharospasm)
- arm/hand (writer’s cramp)
- trunk (axial)
Clinical features of Secondary Torticollis
Secondary CD should be suspected when patients have additional neurologic, orthopedic, or medical disorders or have a history of drug exposure or trauma prior to onset of CD.
Factors Differentiating Primary from Secondary Dystonia
Following factors are seen in secondary dystonia:
- Sudden onset of dystonia
- Onset in an infant or a child
- Severe pain
- Absence of sensory tricks or Geste Antagoniste
- Fixed posture
- Presence of dystonia during sleep
- Rapid progression of dystonia
Additional focal neurological signs.