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Laryngeal dystonia, also called spasmodic dysphonia, is a chronic neurological voice disorder that affects the muscles of the larynx (voice box). It is a type of focal dystonia, meaning it causes involuntary muscle contractions in a specific area of the body.

In this condition, the muscles controlling the vocal cords spasm during speech, disrupting the normal vibration and positioning of the cords. This leads to a strained, breathy, or broken-sounding voice. Symptoms typically appear gradually and worsen over time.

Laryngeal dystonia is not caused by psychological problems, though emotional stress can worsen symptoms.

The cause of laryngeal dystonia is not fully understood, but it is believed to result from dysfunction in brain areas that regulate motor control, particularly the basal ganglia.

Possible contributing factors include:

• A genetic predisposition (though most cases are sporadic)
• A history of other forms of dystonia
• Rarely, neurological injury or illness
• Vocal overuse or trauma may be triggers but are not causes

This condition is not caused by anxiety, depression, or vocal strain alone. However, these factors may influence the severity of symptoms.

1. Adductor Spasmodic Dysphonia (ADSD)

• Most common type.
• Vocal cords spasm tightly closed during speech.
• Voice sounds strained, strangled, or effortful, particularly on voiced sounds (e.g. b, d, g).

2. Abductor Spasmodic Dysphonia (ABSD)

• Less common.
• Vocal cords spasm open, causing breathiness or voice dropouts, especially on voiceless sounds (e.g. p, t, h, f).

3. Mixed Type

• A rare form involving both adductor and abductor spasms.
• May result in a combination of strained and breathy voice patterns.

Symptoms can vary, but commonly include:

• Strained or strangled voice quality
• Breathy or whispery voice
• Sudden interruptions or breaks in speech
• Inconsistent voice quality depending on stress, fatigue, or context
• Effortful speaking or vocal fatigue
• Voice often improves during laughing, whispering, or singing

Symptoms usually do not affect non-speech sounds, such as laughter, whispering, or humming.

Diagnosing laryngeal dystonia involves a multidisciplinary approach and is based on clinical features, as there is no single diagnostic test.

Evaluation may include:

1. ENT (Ear, Nose, and Throat) Specialist Examination

• A flexible laryngoscopy or videostroboscopy allows the doctor to view vocal cord motion during speech.

2. Voice Specialist Assessment

• A laryngologist or neurologist with experience in dystonia may assess speech patterns and muscle behaviour.

3. Exclusion of Other Conditions

• Structural abnormalities, vocal cord paralysis, or other neurological diseases need to be ruled out.

4. Speech Recording and Analysis

• Speech samples help identify characteristic spasms and breaks in phonation.

5. Laryngeal Electromyography (EMG) (in some cases)

• May be used to assess muscle activity and guide treatment.

Because symptoms may resemble other voice disorders, accurate diagnosis by a specialist team is essential.

There is no cure for laryngeal dystonia, but symptoms can be effectively managed, especially with botulinum toxin injections.

1. Botulinum Toxin (BoNT-A) Injections

• Most effective and commonly used treatment.
• Injections are given directly into the overactive laryngeal muscles.
• The toxin reduces unwanted muscle spasms by temporarily weakening the muscle.
• Administered using a fine needle, sometimes with EMG guidance to ensure accurate placement.
• The effect begins within a few days and typically lasts 3 to 6 months, after which injections are repeated.
• Side effects may include:
  • Temporary breathiness
  • Mild swallowing difficulty
  • Hoarseness
• These effects are usually short-lived and improve as the dose stabilises.

Botulinum toxin therapy is tailored to each patient’s type of dystonia and voice pattern. It is considered the gold standard treatment for laryngeal dystonia.

2. Surgical Treatments (Rare in practice)

Surgery may be considered for patients who:

• Do not respond well to botulinum toxin
• Experience side effects that are intolerable

Options include:

• Selective laryngeal adductor denervation-reinnervation (SLAD-R)
  • Involves cutting the affected nerve branches and reconnecting them to reduce spasms.
  • Primarily used for adductor-type dystonia.
• Recurrent laryngeal nerve section
  • An older procedure now used less frequently due to variable results and potential voice changes.

Surgical approaches carry risks and are typically considered only in severe or refractory cases. Outcomes are highly variable. Some patient may still return for botulinum toxin injection treatment even after surgery. 

Laryngeal dystonia is a lifelong condition, but many people are able to manage symptoms effectively with proper treatment.

Helpful strategies include:

• Using written or electronic communication during severe flare-ups
• Avoiding speaking over loud noise
• Taking vocal breaks when needed
• Managing stress and fatigue, which may aggravate symptoms
• Maintaining hydration and avoiding irritants like smoking

Condition

Laryngeal Dystonia (Spasmodic Dysphonia)

Cause

Neurological dysfunction affecting vocal cord control

Main Symptoms

Strained, breathy, or interrupted speech

Diagnosis

Clinical assessment, laryngoscopy, exclusion of other conditions

Treatment

Botulinum toxin injections (first-line), surgery in select cases

Prognosis

Chronic condition; symptoms manageable with ongoing care

Access to support groups and reliable information can help patients cope with the social and emotional impact of this condition.

UK Resources:

• British Voice Association
  www.britishvoiceassociation.org.uk
  Provides patient education, professional voice care information, and specialist contacts.
• Dystonia UK
  www.dystonia.org.uk
  Offers support groups, advice, and updates on dystonia research and care.

International:

• National Spasmodic Dysphonia Association (NSDA)
  www.dysphonia.org
  Offers comprehensive resources for individuals living with spasmodic dysphonia.

Cervical dystonia, also known as spasmodic torticollis, is a neurological movement disorder that causes involuntary muscle contractions in the neck. These muscle spasms cause the head to twist, tilt, or turn to one side, and may be accompanied by tremors, jerky movements, or sustained abnormal postures.

Cervical dystonia is the most common form of focal dystonia and typically develops in adulthood, although it can occur at any age. The condition is chronic, but treatments can significantly reduce symptoms and improve quality of life.

In most cases, the cause is unknown (idiopathic). Cervical dystonia is thought to involve abnormal signalling in the basal ganglia, the part of the brain that helps control movement.

Possible contributing factors include:

• Genetic predisposition – about 10–20% of cases have a family history
• Secondary causes, which are rare, may include:
  • Neck or head injury
  • Stroke
  • Certain medications (especially dopamine-blocking drugs)
  • Other neurological diseases

Cervical dystonia is not caused by psychological conditions, although stress or fatigue can worsen symptoms.

• Most commonly affects adults aged 40 to 60
• More frequent in women than men
• Can occur in children, though this is uncommon

Symptoms may develop gradually and worsen over weeks or months. Common features include:

• Involuntary turning, tilting, or twisting of the head or neck
• Neck pain or discomfort, often on one side
• Muscle tightness or stiffness
• Head tremor (shaky or jerking movements)
• Difficulty maintaining a natural head position
• Sensory tricks (e.g. touching the chin or cheek) that temporarily reduce spasms

Types of abnormal head postures:

Torticollis: Head turns to one side

Laterocollis: Head tilts sideways

Anterocollis: Head tilts forward

Retrocollis: Head tilts backward

In many cases, a combination of these postures may be present.

Cervical dystonia is diagnosed based on clinical assessment by a healthcare professional, usually a neurologist or movement disorder specialist.

The diagnostic process includes:

• Detailed medical history and symptom review
• Neurological examination to observe posture, movement, and muscle activity
• Imaging (MRI or CT) may be done to exclude structural brain or neck issues
• Blood tests or additional investigations may be used to rule out secondary causes

There is no specific test for cervical dystonia. Diagnosis is made based on recognition of symptoms and exclusion of other conditions.

While there is no cure for cervical dystonia, a number of effective treatments can help reduce symptoms and improve neck posture and quality of life.

1. Botulinum Toxin Injections (BoNT-A)

• First-line treatment for most patients
• Small doses of botulinum toxin are injected into the overactive neck muscles
• Temporarily weakens the muscles to relieve spasms and abnormal posture
• Onset of benefit usually occurs within a few days, lasting 3 to 4 months
• Injections are repeated as needed
• Side effects may include:
  • Mild neck weakness
  • Soreness at injection sites
  • Swallowing difficulties (usually temporary)

Botulinum toxin treatment is highly effective in most patients and is usually delivered by a specialist experienced in movement disorders.

2. Oral Medications (used if Botox is not enough or not tolerated)

• Anticholinergics (e.g. trihexyphenidyl) – reduce involuntary muscle activity
• Benzodiazepines (e.g. clonazepam, diazepam) – may help with muscle relaxation
• Baclofen – a muscle relaxant that acts on the spinal cord

These medications may cause side effects such as drowsiness, dry mouth, or dizziness and are typically used cautiously.

3. Surgical Options (for severe, treatment-resistant cases)

• Deep Brain Stimulation (DBS) – involves placing electrodes in specific brain areas (e.g. the globus pallidus) to regulate movement
• Selective denervation surgery – cuts overactive nerves in the neck muscles

Surgery is reserved for carefully selected patients who have not responded to other treatments.

Living with cervical dystonia can be challenging, especially when it affects daily tasks, work, or self-confidence. The following strategies may help:

• Use of sensory tricks (light touch to the chin, cheek, or back of the head)
• Stress management techniques, such as relaxation exercises or mindfulness
• Maintaining good posture and neck support (e.g. ergonomic pillows or chairs)
• Heat therapy or gentle neck stretching
• Support groups to share experiences and coping strategies

Cervical dystonia is a chronic condition, but many patients experience partial or significant symptom relief with appropriate treatment. In rare cases, symptoms may improve spontaneously.

With consistent care and treatment, most people can maintain a good quality of life, though some may require ongoing therapy or adjustments to their treatment plan.

Condition

Cervical Dystonia (Spasmodic Torticollis)

Cause

Neurological dysfunction in movement control pathways

Main Symptoms

Involuntary neck muscle contractions, abnormal head posture, pain

Diagnosis

Clinical evaluation by a neurologist or movement disorder specialist

Treatment

Botulinum toxin injections, medications, surgery in severe cases

Prognosis

Long-term condition; symptoms manageable with appropriate care

If you are concerned about neck spasms, pain, or abnormal head posture, speak to your healthcare provider for an evaluation and guidance on next steps.

UK-Based:

• Dystonia UK
  www.dystonia.org.uk
  Provides patient support, information, and access to resources and support groups.
• Brain and Spine Foundation
  www.brainandspine.org.uk
  Offers help for those affected by neurological conditions.

International:

• Dystonia Medical Research Foundation (DMRF)
  www.dystonia-foundation.org
  Offers educational resources, research updates, and global community support.

Meige Syndrome is a rare neurological condition that causes involuntary muscle contractions (dystonia), primarily affecting the face and neck. It most commonly involves a combination of:

• Blepharospasm – involuntary spasms of the muscles around the eyes, causing excessive blinking or forced eyelid closure
• Oromandibular Dystonia – spasms of the jaw, mouth, tongue, or lower face muscles

These muscle contractions can be intermittent or continuous and may interfere with daily activities such as reading, speaking, eating, or driving. Meige Syndrome typically begins in middle to late adulthood and is more common in women than men.

The exact cause of Meige Syndrome is unknown, but it is believed to be due to abnormal functioning of the basal ganglia, a region of the brain involved in controlling movement.

Potential contributing factors include:

• Genetic predisposition (although most cases are not inherited)
• Environmental triggers, such as long-term use of certain medications (e.g. antipsychotics or anti-nausea drugs)
• Co-existing movement disorders such as other forms of dystonia

Meige Syndrome is not caused by psychological illness, although symptoms may worsen with stress, fatigue, or anxiety.

Typically affects adults between the ages of 40 and 70

• More common in females
• Rare in children or young adults

Meige Syndrome often begins gradually and progresses over time. Common symptoms include:

Blepharospasm (Eye Symptoms):

• Excessive blinking
• Difficulty keeping eyes open
• Uncontrollable eyelid closure (can cause temporary functional blindness)

Oromandibular Dystonia (Mouth and Jaw Symptoms):

• Jaw clenching or opening
• Lip pursing or retraction
• Tongue thrusting or difficulty controlling tongue movements
• Grimacing or facial twitching
• Difficulty speaking (dysarthria)
• Problems chewing or swallowing (dysphagia)

In some cases, spasms may extend to the neck (cervical dystonia) or larynx, affecting voice and posture.

Meige Syndrome is a clinical diagnosis, based on the patient's symptoms and physical examination. There is no specific test to confirm the condition.

The diagnostic process may include:

• Neurological examination to assess muscle movements and rule out other conditions
• Imaging tests (such as MRI) to exclude structural brain abnormalities
• Review of medical history, including medication use
• Sometimes, electromyography (EMG) may be used to assess muscle activity

Diagnosis may be delayed or misattributed to conditions such as dry eye syndrome, anxiety disorders, or temporomandibular joint dysfunction (TMJ).

There is no cure for Meige Syndrome, but symptoms can often be significantly improved with medical and supportive treatments.

1. Botulinum Toxin Injections (Botox)

• First-line treatment for both blepharospasm and oromandibular dystonia
• Injections are administered into the overactive muscles to reduce spasms
• Effects begin within a few days and typically last 3–4 months
• Repeat treatments are usually necessary
• Side effects are generally mild and may include temporary weakness in nearby muscles or slight asymmetry

2. Oral Medications (less commonly effective)

Used when Botox alone is insufficient or not tolerated. These may include:

• Anticholinergics (e.g. trihexyphenidyl)
• Benzodiazepines (e.g. clonazepam)
• Baclofen (a muscle relaxant)
• Tetrabenazine (dopamine-depleting agent)

These medications may help reduce the severity of spasms but can cause side effects such as drowsiness, dry mouth, or cognitive changes.

3. Surgical Options (in rare, severe cases)

For patients who do not respond to other treatments:

• Deep Brain Stimulation (DBS): Electrodes are implanted in specific brain areas to modulate motor control. May reduce symptoms of dystonia.
• Myectomy: Surgical removal of overactive muscles (mainly used for severe blepharospasm)

Surgery is considered only in highly selected cases.

Living with Meige Syndrome can be challenging, particularly due to its impact on communication, vision, and self-image. These strategies may help:

• Wearing tinted glasses (FL-41 lenses) may reduce light sensitivity that triggers blepharospasm
• Stress reduction techniques (e.g. mindfulness, breathing exercises)
• Use of adaptive devices or assistive communication tools during flare-ups
• Hydration and nutrition support, particularly if eating is affected
• Involvement in patient support groups for emotional and practical advice

Meige Syndrome is a chronic condition, but it does not shorten life expectancy. Symptoms tend to progress slowly and may plateau over time. While it can be disabling, especially in severe cases, many patients achieve a good level of symptom control with treatment.

Contact your doctor if you experience:

• Persistent blinking or facial twitching
• Difficulty keeping your eyes open
• Unexplained facial, mouth, or jaw spasms
• Trouble speaking, eating, or swallowing

Early recognition and referral to a neurologist with expertise in movement disorders can lead to effective treatment and improved quality of life.

Condition

Meige Syndrome

Symptoms

Involuntary spasms of the eyes, jaw, mouth, and sometimes neck

Cause

Neurological dysfunction (dystonia of facial muscles)

Diagnosis

Clinical assessment by neurologist

Treatment

Botulinum toxin injections (first-line), oral medications, surgery in rare cases

Prognosis

Chronic but manageable with treatment

UK-Based:

• Dystonia UK www.dystonia.org.uk Information, support, and connections to specialist care.
• British Neurological AssociationOffers patient education and clinician directories.

International:

• Dystonia Medical Research Foundation (DMRF) www.dystonia-foundation.org Offers information on treatment, clinical trials, and patient networks.

Anterocollis is a medical condition where the neck bends forward, causing the chin to drop toward the chest. It results in a flexed head and neck posture that may be intermittent or fixed and can range from mild to severe.

This abnormal posture can significantly affect vision, balance, swallowing, breathing, and daily function. It is commonly associated with neurological disorders, especially Parkinson’s disease, multiple system atrophy (MSA), and other types of dystonia, but it may also occur in muscle disorders or as a side effect of certain medications.

Anterocollis is usually due to abnormal muscle activity or muscle weakness affecting the neck muscles.

Common underlying causes include:

1. Neurological Conditions
   • Parkinson’s disease
   • Multiple system atrophy (MSA)
   • Progressive supranuclear palsy (PSP)
   • Focal dystonia (a movement disorder causing involuntary muscle contractions)

1. Myopathy (Muscle Disease)
   • Conditions that directly weaken the neck extensor muscles (e.g. myositis, inclusion body myositis)

1. Medication Side Effects
   • Certain drugs, particularly dopamine agonists, antipsychotics, or antiemetics, may induce dystonia or postural abnormalities

1. Structural or Degenerative Conditions
   • Cervical spine disease or arthritis causing postural change

In many cases, especially in neurological disorders, anterocollis results from a combination of excessive contraction of neck flexors and weakness of neck extensors.

• Most often seen in adults, particularly those with Parkinsonian syndromes
• Can occur in people taking certain medications
• Rare in children unless associated with congenital or genetic conditions

Symptoms of anterocollis may vary in severity and presentation. Common features include:

• Forward drooping of the head
• Difficulty holding the head upright, especially when walking or sitting
• Neck pain, stiffness, or muscle fatigue
• Obstructed vision, needing to tilt the eyes upward
• Difficulty with swallowing, speaking, or breathing
• Social embarrassment or self-consciousness due to posture

In some cases, the abnormal posture improves when lying down or resting but worsens during activity.

Diagnosis of anterocollis involves a thorough clinical assessment to identify the underlying cause and guide treatment.

Evaluation may include:

• Neurological and physical examination
• Assessment of posture while sitting, standing, and walking
• Electromyography (EMG) – to evaluate muscle activity and identify dystonia or weakness
• Imaging (MRI or CT scan) – of the brain or cervical spine if structural causes are suspected
• Blood tests – to screen for myopathy or inflammatory conditions
• Medication review – to check for drug-induced causes

In cases linked to Parkinson’s disease or other neurodegenerative conditions, the diagnosis may be made as part of the broader disease management.

There is no one-size-fits-all approach to treating anterocollis. The best treatment depends on its cause, severity, and impact on daily life.

1. Medication Review and Adjustment

• If anterocollis is linked to a medication, changing or discontinuing that drug may lead to improvement.
• In Parkinson’s or MSA, adjusting dopaminergic therapy may help.
• In cases with dystonia, medications like anticholinergics, muscle relaxants, or benzodiazepines may be considered.

2. Botulinum Toxin Injections (BoNT-A)

• Targeted injections into overactive neck flexor muscles can reduce muscle contraction and improve posture.
• Effects typically last 2–4 months, and treatments may be repeated.
• Results vary by individual and underlying condition.

3. Physiotherapy and Rehabilitation

• Stretching and strengthening exercises focused on the neck and upper back
• Postural training with the help of physiotherapists
• Use of mirror feedback or visual cues to encourage upright positioning
• Gait and balance training to reduce fall risk

A physiotherapist with experience in neurological conditions can design a tailored programme.

4. Neck Supports and Bracing

• Use of a soft neck collar (like a chunky travel pillow) can support the head temporarily during activities
• Custom-made braces or orthoses may help in moderate to severe cases
• Overuse of neck braces can lead to muscle deconditioning, so use is typically limited

5. Surgical Options

• Considered only in rare, severe, and treatment-resistant cases

May include procedures such as deep brain stimulation (DBS) in selected patients with dystonia or Parkinson’s disease

Living with anterocollis can be physically and emotionally challenging, especially when it affects vision, communication, and independence.

Helpful coping strategies:

• Use adaptive furniture such as high-backed chairs or reclining seats
• Take frequent breaks when upright to relieve strain
• Use voice amplifiers or writing aids if communication is difficult
• Modify home environments to reduce fall risk
• Engage with support groups or mental health professionals if anxiety or self-esteem is affected

A multidisciplinary team—including neurologists, physiotherapists, occupational therapists, and speech therapists—can provide coordinated care.

You should consult your doctor if you:

• Notice progressive or sudden head drop
• Experience neck pain or discomfort
• Have difficulty eating, breathing, or speaking
• Are taking medications that could contribute to postural changes
• Have an existing neurological diagnosis with new or worsening neck symptoms

Early intervention improves the chances of successful symptom management.

Condition

Anterocollis (forward neck flexion)

Common Causes

Parkinson’s disease, multiple system atrophy, dystonia, myopathy, certain medications

Main Symptoms

Head drooping, neck pain, difficulty with vision, swallowing, or speaking

Diagnosis

Clinical evaluation, EMG, imaging, and medication review

Treatment Options

Medication adjustment, botulinum toxin, physiotherapy, neck support, surgery (rare)

Prognosis

Chronic condition; symptoms may be managed with combined therapies

• Experience neck pain or discomfort
• Have difficulty eating, breathing, or speaking
• Are taking medications that could contribute to postural changes
• Have an existing neurological diagnosis with new or worsening neck symptoms

Early intervention improves the chances of successful symptom management.