Natural history of adult-onset idiopathic torticollis
M. Jahanshahi, M. H. Marion and C. D. Marsden
Department of Clinical Neurology, Isntitute of Neurology, National Hospital, London, England.
The rates of spontaneous remission and progression of dystonia to other
sites were studied in 72 patients who first presented with adult-onset
torticollis, and who were followed up for a mean of 7.7 years. Dystonia had
progressed to sites other than the neck (mainly the face and upper limbs)
in 23 patients (32%). The latter cases were not differentiated from those
with isolated torticollis in terms of any of the demographic or clinical
features studied, although they tended to have suffered from torticollis
longer. Fifteen patients (20.8%) had experienced a spontaneous remission of
their torticollis, which was sustained for a median period of 3 years in 9
cases (12.5%). Eighty-seven percent of the 15 remissions had occurred
during the first 5 years of the illness. In the 9 cases with sustained
remission, the duration of torticollis before spontaneous remission was
significantly longer and remission had mostly occurred after 2 years of
illness compared with the 6 who had relapsed. The 15 cases with spontaneous
remission tended to have an earlier age of onset compared with those with
no remission. Sixty-five percent of cases were correctly classified on the
basis of age at onset, which emerged as the only salient variable in the
discrimination of the 15 patients with spontaneous remission from the 57
without spontaneous remission. Age at onset, form of torticollis, gender,
and direction of head deviation resulted in a correct classification rate
of 70%, in the discrimination of the 9 cases with sustained remission from
those with no remission.(ABSTRACT TRUNCATED AT 250 WORDS)
