Torticollis is a stiff neck associated with muscle spasm. It accompanies the condition of one’s head tilted to one side due to lateral flexion contracture of the cervical spine musculature. Although torticollis has generally been treated with medications or muscle relaxing injections, these non-surgical treatments often cannot cure torticollis completely.

Typical symptom of torticollis is muscle tension dystrophy it occurs due to disorders of central nerve system that controls tension and contraction of the muscles. Torticollis patients suffer from discomfort and pain as well as psychological problem. The cause of torticollis is yet to be identified, but the functional abnormality of basal ganglia in the brain is largely estimated as the possible cause of the disease. The basal ganglia are associated with the function of voluntary motor control. Thus, the damage on the basal ganglia sends out incorrect signal inflicting involuntary contraction, relaxation and tremor of muscles. Torticollis is easily mistaken for a stroke or other disease as it often makes sudden appearance on adults. Epidemiological study in Europe indicates that over 50 million patients across Europe didn’t recognize their muscle tension dystrophy was due to torticollis at the beginning.

Blinking eyes frequently, jaw or tongue tremor, and stiffness in hand or arm muscles when playing instrument or writing are also the representative symptoms of torticollis. Medications and topical Botox injections are prescribed for early stage or mild case of torticollis. Especially repeated Botox injection reduces its therapeutic effect and the intervals between injections because of immune response in vivo. Therefore combined therapy of psychiatric consultation, rehabilitation, and Korean medicine must be provided appropriately depending on the patient’s condition.

If the symptoms do not improve with conventional treatment, surgery must be performed. There are two surgical methods – selective peripheral nerve resection and deep brain stimulation. Selective peripheral nerve resection cuts off peripheral nerves that control neck muscles. This surgery delivers immediate result for patients suffering from stiff neck, but it has the disadvantages; possibility of damaging peripheral nerve due to complex surgical procedure and difficulties in pain management. On the contrary, deep brain stimulation implants a type of pacemaker to generate impulse for electrical stimulation on the part of the brain associated with torticollis. Deep brain stimulation is gaining popularity recently as it minimizes nerve damage and can be replaced with new treatment at any time.