The pathophysiologic mechanisms of spasmodic torticollis and other idiopathic torsion dystonias remain unknown. Thus, a variety of drugs have been used alone or in combination on an empirical basis to treat these disorders, but to date none have efficacy that is proven and consistent. The drugs in use include anti-cholinergics, benzodiazepines, dopaminergics , and neuroleptics. The variable responses that have been observed are due in part to the heterogeneous nature of these disorders. Trial of several agents or combinations of agents may be necessary before symptoms are satisfactorily controlled. Only when a patient's symptoms are refractory to all medical treatment should he or she be considered a candidate for neurosurgical procedures.