Abnormal interaction between vestibular and voluntary head control in patients with spasmodic torticollis

The functional status of vestibulo-collic reflexes in the sternocleidomasto id (SCM) muscles was investigated in 24 patients with spasmodic torticollis using small, abrupt (drops' of the head. None had been treated with botuli num toxin injections during at least 4 months preceding the study. Eight of the patients, four of whom had been studied before surgery, were also stud ied after selective peripheral denervation of neck muscles. The reflex was of normal latency and duration in the 'passive drop' condition, in which su bjects were instructed not to oppose the fall of the head. To study volunta ry interaction with the reflex response, subjects were then asked to flex t he neck as quickly as possible after onset of the head drop ('active drop') . In this condition, voluntary responses in patients were delayed, smaller and less effective in counteracting the head fall than in normal subjects. The same abnormalities were also found in patients after surgery when the h ead posture was improved, Somatosensory/auditory voluntary reaction times i n SCM were normal, as was the latency of the startle reflex. We conclude th at voluntary interaction with the vestibulo-collic reflex is disrupted in p atients with spasmodic torticollis, a finding which corroborates the patien ts' aggravation of their symptoms by head or body perturbations. Lack of ef fective interaction between two major systems controlling head position may contribute to torticollis.