Factors that ameliorate or aggravate spasmodic torticollis

A sample of 72 patients with adult onset torticollis were asked to complete a checklist to indicate how a list of situations and activities affected t he severity of their torticollis. Stress and self consciousness were report ed as aggravating factors by more than 80% of the sample, whereas walking, fatigue, and carrying objects were noted as exacerbators by over 70% of the patients. For more than 40% of the sample, torticollis improved in the sup ine position, by relaxation, sleep, and lying on the side. However, the las t four factors also worsened the head deviation in 16% to 25% of the patien ts. Use of a "geste antagoniste" to maintain the head in the body midline, was reported by 64 (88.9%) of the patients, which was still effective in co rrecting head position in 47%. The sensitivity of torticollis to social and emotional factors can be best explained in terms of a possible link betwee n extrapyramidal and affective disorders through overlapping changes in cat echolamine metabolism. The worsening of torticollis with peripheral motor a ctivity (walking, running, writing) or its improvement with changes in body posture or with the geste antagoniste is best viewed in terms of alteratio ns of peripheral proprioceptive feedback or central corollary discharge pro voked by the motor output or command.