Spastic Torticollis

  I have suffered from Spastic Torticollis for over the past 18 years.  I have tried biofeedback with little success.  I presently do a range of motion excercises to relieve the discomfort but the involuntary movement of my head to the left remains constant.  I can prevent this involuntary turning by placing my hand in contact with my jaw.  The associated muscle spasms are distracting.  My right sternoclienomastoid muscle is enlarged. When I use ativan (0.5mg) the symtoms (symptoms) are reduced.  Can I continue with the ativan indefinitely without building a tolerance to the drug.  I am reluctant to try  Botox because I have little confidence in that treatment mode as the dosage must be increased as the treatment procedes.  Can you suggest any other therapy or drug that may help without side effects or dependency?
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We see quite a few patients with spasmodic torticollis (cervical dystonia) at the Cleveland Clinic. Treatment with medications sometimes works (for example, clonazepam or trihexiphenidyl), but most people get the best relief from botulinum toxin. In your case, symptoms seem very typical for what we'd expect of dystonia, including the so-called "geste antagonistique" which is what the French call it when you put your hand on your face.
If you did well with Ativan (lorazepam), then Klonopin (clonazepam) may be beneficial. Ativan does lead to tolerance and dependence on a greater dose with time. Klonopin does, too, but maybe to a less extent.
I'm not sure where you got the information that Botox dose must increase with time. It is true that the effects are not as long-lasting in some people as time goes on, but it is not a certainty.
If you are interested in a second opinion or trying out some medications you haven't yet tried, you are welcome to call 800 223 2273 and ask for neurology appointments. CCF MD mdf.