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PubMed1990

Failure of fixed-dose, fixed muscle injection of botulinum toxin in torticollis.

We studied the effect of botulinum toxin injection in 30 patients with torticollis in a double-blind, placebo-controlled, crossover study. A fixed dose of toxin was injected into the contralateral sternocleidomastoid and both trapezius muscles. Clinical improvement was assessed by a rating scale and by patient self-evaluation. Subjective rating noted improvement in some patients, but there was no change in objective measures. The use of larger doses and injection of additional muscles may be necessary to achieve increased efficacy of botulinum toxin in the treatment of torticollis.

Adult↗
PubMedDate not supplied

Mexiletine in the treatment of torticollis and generalized dystonia.

Mexiletine is an antiarrhythmic drug that has been reported to exert antidystonic properties. We performed an open-label study to collect further evidence of the antidystonic effect of mexiletine in spasmodic torticollis (ST) and to evaluate its possible use in generalized dystonia. We administered mexiletine to six patients with dystonia (three with generalized dystonia and three with ST) who had failed to respond to previous pharmacotherapy. The drug was started at a dose of 200 mg/d by mouth and increased up to a maximum dose of 800 mg/d. Patients were evaluated at regular intervals over a 6-week period with use of the Fahn & Marsden Dystonia Scale and the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and videotaped. At the end of the trial, the videotapes were reviewed and scored by a blind observer. Patients were then followed for at least 1 year and evaluated every 3 months at the dose reached during the study period. No adverse effects were reported in five patients; in one patient, dizziness developed at the dosage of 800 mg/d, requiring a reduction of the dose. At the end of a 6-week period, a significant improvement in the rating scale for dystonia and in videotape ratings was observed after mexiletine treatment (p < 0.01). Our data indicate that mexiletine is a useful drug in dystonia treatment.

Adult↗
PubMed2002

Longitudinal followup study of ultrasonography in congenital muscular torticollis.

High-resolution ultrasonography was used to examine affected sternocleidomastoid muscles in patients with congenital muscular torticollis at different times. Thirty-one female and 42 male patients were recruited and classified as having one of four types of fibrosis based on the sonograms. Compared with initial assessment, 22 (95.6%) patients with Type I fibrosis and 22 (57.9%) patients with Type II fibrosis had a change in classification at the end of the study. Among the patients with Type I fibrosis, the classification of one patient was changed to Type III fibrosis, the classifications of two patients were changed to normal muscle, and the classifications of the other patients were changed to Type II fibrosis. For patients with Type II fibrosis, the classifications of two patients were changed to Type III fibrosis, the classifications of three patients were changed to Type IV fibrosis, and the classifications of the other patients were changed to normal muscle. No changes in classification of patients with Types III and IV fibrosis occurred during followup. Patients with Type IV fibrosis had a significantly high incidence of surgical intervention. Congenital muscular torticollis is a dynamic disease. Ultrasonography can be valuable in observing the alteration. Aggressive management may be necessary for patients with Type IV fibrosis.

Child↗
PubMedDate not supplied

Treatment of congenital muscular torticollis in patients older than 8 years.

The authors treated congenital muscular torticollis by sternocleidomastoid muscle release in 32 patients over 8 years of age who had not received any prior medical treatment or in whom torticollis had recurred since initial treatment. The results were analyzed to compare clinical results after an average of 39 months (range 24-74 months) by dividing the patients into two groups: patients who were still in the growing period (group 1, n=19) and patients who had finished growth (group 2, n = 13) at surgery. According to the total score table by Cheng et al (which includes motion deficits, craniofacial asymmetry, scar, band, head tilt, and subjective assessment), there were 13 excellent and 6 good results in group 1 and 2 excellent, 8 good, and 3 fair results in group 2. The clinical results were statistically less successful in group 2 than in group 1 by Cheng's score table (P <0.05). However, most patients showed marked improvement in neck motion and head tilt, with satisfactory functional and cosmetic results. Thus, in patients older than school age, even for those who have finished growth, sufficient unipolar or bipolar release of the sternocleidomastoid muscle and intensive postoperative care are expected to yield satisfactory treatment results.

Adolescent↗
PubMedDate not supplied

Congenital muscular torticollis.

Congenital muscular torticollis is a painless condition usually presenting during infancy with a tight sternocleidomastoid muscle causing the child's head to be tilted to the tightened side. Limited neck motion and a palpable tumor within the muscle are often present. A regimen of stretching exercises is the most common form of treatment with positive outcomes for over 90% of the identified cases. Rarely children require surgical intervention to release the tightened muscle. Botox injections to relax the tight muscle is a new form of treatment being used by some practitioners. Torticollis also presents as a symptom for a variety of muscular, bony, and neurologic conditions, which are briefly reviewed in this article.

Botulinum Toxins, Type A↗
PubMed1998

Endoscopic surgical treatment for congenital muscular torticollis.

Muscular torticollis, if untreated, may result in significant permanent craniofacial deformities. Surgical release of the sternocleidomastoid muscle is recommended for patients who fail to respond to physical therapy. Current surgical techniques all leave noticeable scars, and provide limited exposure. These limitations make complete muscular release and visualization of the spinal accessory nerve difficult. We have applied a new technique of endoscopic release of the sternocleidomastoid muscle in 12 infants and children ages 4 to 18 months and one adolescent with muscular torticollis. Complete muscular release was achieved in all patients with one minor complication. The spinal accessory nerve was preserved in all cases. Our endoscopic approach allows precise division of the muscle fibers and preservation of neurovascular structures, leaving an inconspicuous scar in the scalp.

Adolescent↗
PubMed2006

Cervical myelopathy from atlantal hypoplasia and torticollis.

Cervical myelopathy caused by atlantal hypoplasia has been reported in only 11 patients. Atlantal hypoplasia combined with torticollis has not been reported. Rotation of the atlantoaxial joint causes spinal canal narrowing at the atlantoaxial level and stretches the vertebral artery, which may aggravate the symptoms and signs of compressive cervical myelopathy from atlantal hypoplasia. We present a patient with cervical myelopathy from atlantal hypoplasia, retrodental pseudotumor, and torticollis.

Aged↗
PubMed2006

Progressive congenital torticollis in VATER association syndrome.

STUDY DESIGN: A family study to reach the diagnosis of a multiple malformation syndrome. OBJECTIVE: To determine the cause of torticollis, in a patient with the VATER association. SUMMARY OF BACKGROUND DATA: The VATER association is a combination of vertebral anomalies, anal stenosis, tracheo-esophageal fistula, and radial anomalies. It needs a multidisciplinary approach with a major input from orthopedic surgeons. Torticollis in this condition has not been reported before. METHODS: Detailed family history and radiologic study using plain radiographs and three-dimensional-reconstruction. RESULTS: Bony abnormalities at the base of the skull and upper cervical vertebrae were found. CONCLUSIONS: It is postulated that the bony abnormalities were the underlying cause of the neurologic problem.

Abnormalities, Multiple↗
PubMed2006

The coconut condyle: occipital condylar dysplasia causing torticollis and leading to c1 fracture.

In this report we discuss the case of a child who was initially diagnosed at 1 month of age with congenital muscular torticollis. After falling off a slide at 22 months of age, the patient had onset of pain and an abrupt worsening of his torticollis. After a full workup, it was found that the patient had a C1 fracture and a disproportionately large ipsilateral occipital "coconut" condyle. We believe this congenital anomaly to be the cause of his original head tilt and also predisposed him to C1 fracture and worsening head tilt.

Bone Diseases, Developmental↗
PubMedDate not supplied

Surgical correction of muscular torticollis in the older child.

Thirty-three children between 6 and 16 years of age who were treated for muscular torticollis were followed up from 2 to 10.5 years after surgery. All patients had a distal open release of the sternocleidomastoid muscle. Preoperative and postoperative assessment by a rigid scoring system showed that all patients improved in terms of function as well as cosmesis. Children less than 12 years of age showed the most improvement, with 71% excellent and good results. Late release of the sternomastoid in muscular torticollis can, therefore, give acceptable results.

Adolescent↗
PubMed1985

Idiopathic spasmodic torticollis.

Idiopathic spasmodic torticollis (IST) is discussed from the perspective of definition and description, clinical presentation, and modes of treatment including a new, innovative, surgical approach. The role of the physician and the neurosurgical nurse in the management of idiopathic spasmodic torticollis is considered.

Amantadine↗
PubMed2006

Torticollis as a sign of cervico-thoracic epidural haematoma in an infant with severe haemophilia A.

We describe the case of a spinal epidural haematoma in an infant with severe haemophilia A. Initial signs and symptoms were non-specific resulting in delay of the diagnosis and more definitive therapy. The patient eventually developed torticollis, acute flaccid paralysis of the upper extremities, and respiratory distress, prompting radiological examination of the spinal cord. The patient was treated with recombinant FactorVIII and laminectomy. Neurological recovery was complete 3 months following the event. We hypothesize that infants with haemophilia may be at higher risk for this rare complication because of their increasing mobility, frequent falls while cruising furniture, and lack of prophylactic factor replacement. Non-specific signs such as irritability without a focus should alert the clinician to this diagnostic possibility. Torticollis should prompt rapid radiological evaluation of the cervical spine with magnetic resonance imaging to avoid delay in diagnosis.

Hematoma, Epidural, Spinal↗
PubMed1980

The surgical treatment of spasmodic torticollis.

The results of upper cervical anterior rhizotomy and accessory nerve section in the treatment of twenty patients with spasmodic torticollis are reviewed. The majority of these patients presented with pain in addition to postural deformity. There was no evidence in any of them to suggest that the condition was psychogenic. Good results can be expected, particularly in those patients without evidence of cervical spondylosis. We suggest that in symptomatic torticollis surgery is more effective than medical, psychiatric, or other described forms of treatment. Electromyography may be helpful to delineate the affected musculature and to assess postoperative improvement. The operating microscope is a valuable adjunct to surgery to preserve radicular vessels and ensure total division of the relevant motor roots.

Accessory Nerve↗
PubMed1977

A psychometric stury of 34 patients afflicted with spasmodic torticollis.

The clinical and psychometric comparison of two group of patients, one with spasmodic torticollis, the other with operated herniated disc, showed closely related psychological profiles. The most important perturbations are found in spasmodic torticollis and seem related to the disease's chronicity. In no case was a predominant hysteric structure found. The results of these investigations on the disorder's etiology are discussed.

Adult↗
PubMed1984

Spasmodic torticollis: treatment with Tizanidine.

A randomized double-blind cross-over study was performed to compare the efficacy of Tizanidine to that of placebo in the treatment of spasmodic torticollis. No evidence was found that Tizanidine was effective in 10 patients with spasmodic torticollis who received Tizanidine during 6 weeks, up to a dose of 12 mg a day.

Adolescent↗
PubMed1984

Aetiology and pathogenesis of congenital torticollis and head scoliosis in the equine foetus.

In 214 cases of severe dystocia in mares, of which 141 (66 per cent) were Draught horses, deviation of the head and neck, with or without torticollis, malformed head and limbs were found to be the cause of dystocia. No evidence of a genetic lethal factor was found and torticollis was often combined with scoliosis of the head and, frequently, with malformation of one or more limbs. This is considered evidence of a common aetiology and pathogenesis of the syndrome of malformation. The malformations were found to be associated with an increased incidence of caudal and, particularly, transverse presentations. These findings are presented as evidence to support the hypothesis that, during the second half of pregnancy, the narrow tip of the uterine horns provides only limited space for the developing cranial half of the foetus. The surprisingly rapid and complete anatomical and functional recovery of severe malformations of the bones of the neck, head and limbs of surviving foals, born by caesarian section, is taken as further evidence that these malformations have no genetic basis, but originate from unfavourable intrauterine conditions.

Abnormalities, Multiple↗
PubMed2004

Effects of botulinum toxin type A on vibration induced facilitation of motor evoked potentials in spasmodic torticollis.

BACKGROUND AND AIMS: It has not been clarified if botulinum toxin (BTX) injection leads to muscle spindle dysfunction in man. This study aimed to test the hypothesis that BTX application reduces the facilitation of a magnetic evoked response (MEP). METHODS: We used the vibration induced facilitation of an MEP of the sternocleidomastoid muscle (SCM) as a surrogate marker for muscle spindle function in 20 healthy subjects and 10 patients with idiopathic rotational torticollis in whom BTX was injected unilaterally. RESULTS: The increase in the amplitude and area of the MEPs in the clinically not affected and untreated SCM of the patients did not differ significantly from the controls. At baseline, the vibration induced increase in the affected SCM of the patients was significantly lower than in the control group. Six weeks after BTX application, the observed facilitation decreased significantly (amplitude and area: p<0.001) when compared with baseline values. Twelve weeks after BTX application, facilitation showed an increase in the values of the amplitude (p<0.001), but not of the area when compared with the six week examination. CONCLUSIONS: We demonstrated that the vibration induced MEP facilitation in the SCM of patients with torticollis significantly decreased six weeks after BTX application and again increased after 12 weeks in part when looking at MEP amplitude. This observation is suggestive of denervation and reinnervation of the muscle spindles after BTX injection.

Adult↗
PubMed1970

On the problem of the pathology of spasmodic torticollis in man.

Those regions which have been implicated by experimental and clinical neuropathological studies in the pathogenesis of spasmodic torticollis were examined in detail in the present patient and no histological abnormalities found. In the light of marked species differences in the effects of certain brain lesions on posture and the findings reported here, the pathogenesis of spasmodic torticollis in man may well be different from its pathogenesis in experimental animals.

Aged↗