Spasmodic torticollis, Cervical dystonia?

[thabiso]

Hi guys,

Have a middle aged male patient (a bank manager by profession) who presented with right sided sternocleidomastoid twitches. Was recommended to go for physio after one of his superiors noted that his problem wasnt getting any better. Apparently was being treated at one of the hospitals but there had been no response to medical management. the diagnosis was torticollis.

He was experiencing pain in levator scapulae, upper trapezius and splenius capitis but scm was okay. The cervical spine itself appeared to be okay on assessement. When we saw him we sent him to a physician because his finger-to-nose test indicated showed some coodination problems. The physician put him on prednisolone, an NSAID and CPZ but did not give a diagnosis.

When he came back after 3 weeks the pain was better but the twitches were still there and were what was bothering most. We got hold of a dystonia website and it seems to point to this problem as cervical dystonia(the patient would also genlty touch his cheek to control the mvts! He said that would help a bit but not entirely) . This is the first time to encounter this. Has anyone ever treated this condition and what is the physio management. Help