Prognosis
General prognosis
In general, acquired torticollis is not a progressive disorder. Most patients experience stabilisation within 5 years of initiation of therapy.[55] In a cohort of 77 patients followed up for a mean of 7.7 years:[56]
Symptoms continued without spread to other body regions in 39 (51%) patients
Dystonia spread of beyond the neck in 23 (32%) patients
Nine (13%) patients had spontaneous and sustained remission, and 6 patients (8%) had remission followed by relapse.
Quality of life
In a postal survey with a generic quality-of-life questionnaire, patients with acquired torticollis indicated a reduction in quality of life that was comparable with patients with Parkinson's disease, stroke, and multiple sclerosis.[57] Both selection and response bias would tend to cause over-estimation of disease severity in such a study by disproportionately sampling severe cases.
Depression is found in nearly one half of patients and is a predictor of poor quality of life.[58] Discovery and treatment of comorbid depression is important to maintaining quality of life for patients.
Patients often report experiencing social stigmatisation, and study subjects presented with pictures of patients with acquired torticollis and age-matched controls tended to rate patients as less trustworthy, less attractive, and less confident.[59]
Patient education and honest discussion about these issues, with attention to comorbid social anxiety, are important to maximising quality of life.
Disability
In case series, rates of occupational disability range from 20% to 50%.[60][61][62]
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