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PubMed1974

Protein pattern or cerebrospinal fluid in spasmodic torticollis.

The protein patterns found on isoelectric focusing and quantitative paper electrophoresis of cerebrospinal fluid were studied in three patients with spasmodic torticollis. Very alkaline end fractions were found on isoelectric focusing in the CSF-gammaglobulin region in each case. Alkaline end fractions in the CSF-gammaglobulin region with similar or same isoelectric points have also been observed in other extrapyramidal disorders, particularly Huntington's chorea, and in other neurological diseases, especially in multiple sclerosis. It has to be shown if these alkalline end fractions consist of the same or different compounds, conceivable constituents being mentioned. Examination of the CSF-protein pattern might help to distinguish organic from hysterical torticollis.

Adult↗
PubMed1978

Spasmodic torticollis: a combined clinical study.

The prognosis in 30 patients with spasmodic torticollis proved to be unexpectedly bad, only one patient making a full and sustained recovery. Investigation did not confirm previously reported reflex influences on the degree of spasm. Detailed otological investigation did not suggest that spasmodic torticollis originates in vestibular dysfunction. Psychological assessment of the patients showed no deviation from normal in premorbid personality but confirmed the severe adverse effects of the condition.

Adult↗
PubMed1984

Remission in spasmodic torticollis.

In 26 patients with spasmodic torticollis followed up for a median period of 12 years, the frequency of sustained remission was 23%, the median duration of remission was 8 years and duration of torticollis before remission 3 years. These results are more favourable than stated in the literature and should be taken into consideration before recommending surgical treatment.

Adult↗
PubMed1986

Vestibular involvement in spasmodic torticollis.

Vestibular findings in a group of 35 patients with spasmodic torticollis without other otological or neurological symptoms were reviewed. The most consistent abnormality, present in more than 70% of cases, was a directional preponderance of vestibular nystagmus in the dark in a direction opposite to the head (chin) deviation. Rigidly clamping the head to a rotating chair did not abolish the directional preponderance. In the presence of optic fixation the directional preponderance was less frequent and its severity tended to diminish as a function of the duration of the disease. Smooth pursuit and optokinetic nystagmus were only occasionally affected. The results are indicative of primary involvement of the vestibular system in spasmodic torticollis and are discussed in terms of a break-down of the central mechanisms conveying sensory information responsible for head and eye orientation.

Adult↗
PubMed1988

Botulinum toxin in spasmodic torticollis.

Ten patients with spasmodic torticollis were treated by injection of a total dose of 30 ng of botulinum toxin type A into the affected sternomastoid and posterior cervical muscles. Nine patients reported improvement in head position and control, which was confirmed in seven cases by clinical assessment and "blind" videotape ratings before and 6 weeks after injection. Five patients who had pain reported relief. Seven patients had mild transient dysphagia after injection; two who were given a more concentrated solution of the toxin developed more severe dysphagia, but this also recovered. Other minor transient side effects included weakness of the voice and local pain. The beneficial effects of botulinum toxin injections lasted some 2 to 3 months. A slight reduction in the total dose of toxin injected avoided the main side effects, and this method of treatment appears to offer successful control of head position and pain in the majority of patients with torticollis.

Adult↗
PubMed1990

Saccadic function in spasmodic torticollis.

Twelve patients with idiopathic spasmodic torticollis were compared with 19 normal controls on tests of saccadic eye movements thought to depend upon normal basal ganglia function. The patients were able to make random, predictive, remembered, and self-paced saccades equally as well as control subjects. This suggests that those parts of the basal ganglia which may be damaged in spasmodic torticollis, are separate from pathways responsible for the normal initiation and execution of saccades.

Adult↗
PubMed1995

Botulinum toxin F in the treatment of torticollis clinically resistant to botulinum toxin A.

Two reports have shown a Japanese preparation of botulinum toxin type F (BTX-F) to be an effective alternative for patients with torticollis who develop clinical resistance to botulinum toxin type A (BTX-A). A group of patients with torticollis, comprising five secondary non-responders and one primary non-responder, were treated with a preparation of BTX-F produced in the UK (Speywood Pharmaceuticals). A low dose of BTX-F (220 mouse units (MU) in total) was given into clinically affected neck muscles, followed six weeks later by an injection of a total of 520 MU. Antibodies to BTX-A (mouse protection assay) were present in all secondary non-responders but not in the primary non-responder. No patients developed atrophy after injection of Dysport BTX-A (40 MU) into the left extensor digitorum brevis muscle whereas pronounced atrophy occurred in all patients after injection of 40 MU of BTX-F into the right extensor digitorum brevis muscle. Three patients improved subjectively after treatment with 220 MU BTX-F and five (all secondary non-responders) after the subsequent dose of 520 MU (two considerably), with reduced Tsui scores, but group scores were only significantly changed after the higher dose. The primary non-responder remained unchanged after both doses of BTX-F. One patient reported mild dysphagia with 520 MU BTX-F. Mean duration of improvement with 520 MU BTX-F was five (range 4-6)weeks. Thus BTX-F provides benefit for BTX-A non-responders with few side effects but for a shorter period than BTX-A, possibly due to relative underdosing. As with BTX-A, biological sensitivity to BTX-F does not necessarily predict a clinical response.

Adult↗
PubMed1999

Donders' law in torticollis.

We investigated head movements of patients with spasmodic torticollis toward targets in various directions. These patients, whose severe dystonia was reflected in an abnormal resting head position, appeared to retain a Donders'-type strategy for the control of the rotational degrees of freedom of the head. As in normals, rotation vectors, representing head orientation, were confined to a curved surface, which specifies how head torsion depends on gaze direction. The orientation of the surface in body coordinates, which was very stereotyped in normals, was different for patients. The same Donders surface was found for head movements and for stationary head postures, indicating that the same neural mechanism governs its implementation in both tasks. To interpret our results, we propose a conceptual scheme incorporating the basal ganglia, which are thought to be involved in the etiology of torticollis, and an implementation stage for Donders' law.

Aged↗
PubMed2000

Selective denervation and resection of cervical muscles in the treatment of spasmodic torticollis: long-term follow-up results in 207 cases.

OBJECT: To report the outcome of patients with selective denervation and resection of cervical muscles for spasmodic torticollis. METHODS: We reviewed 362 cases of surgically treated spasmodic torticollis. 207 patients were followed from 2 years to 29 years. RESULTS: Total or marked relief of symptoms with preservation of normal of nearly normal movements has been obtained in 87.9%. CONCLUSION: This procedure may be recommended if one to two years of conservative therapy does not offer satisfactory relief of symptoms.

Adolescent↗
PubMed2001

Orbicularis oculi and orbicularis oris reflexes in blepharospasm and torticollis spasmodica during spasm-free intervals.

To investigate possible abnormalities of the blink reflex pathways, we analyzed the latencies and amplitudes of the blink reflex responses in the orbicularis oculi (Ooculi) muscle, following supraorbital nerve stimulation, in 19 patients with blepharospasm, 16 patients with torticollis spasmodica and 22 control subjects. Furthermore, in order to examine the suprasegmental control of the responses, the reflex responses were also evoked in the orbicularis oris (Ooris) muscle after stimulation of the ipsilateral supraorbital nerve. The responses were recorded only when subjects had no contractions of the eyelid muscles, either involuntarily, voluntarily or spontaneously; this could be controlled by a sound signal. The metrics of the reflex responses in the Ooculi and Ooris muscles in patient groups were comparable to those in controls. Our data indicate that the afferent and efferent pathways of the reflex arc and the suprasegmental control of the reflex are intact in patients with blepharospasm and torticollis spasmodica, at least during spasm-free intervals. Alterations of responses may occur during spasms due to either segmental or suprasegmental changes.

Adult↗
PubMed2007

Transient sixth nerve palsies and torticollis secondary to parietal arteriovenous malformation.

Arteriovenous malformations (AVMs) can compress on any intracranial structures, and the presence and nature of ophthalmologic symptoms and signs depend on the size and location of the AVMs. We report an 11-month-old girl with parietal fistulous AVM, transient bilateral sixth nerve palsies and torticollis. The postoperative period was uneventful and she was discharged in a good condition. The patient recovered from transient bilateral abducens nerve palsies and torticollis; she was asymptomatic during the 18-month follow-up period.

Abducens Nerve Diseases↗
PubMed1991

Selective peripheral denervation in patients with spasmodic torticollis.

The results of selective peripheral denervation of the involved muscles in 35 patients with spasmodic torticollis are reported. We modified the operation first described by Bertrand. Follow-up was 3 months to 2.5 years in 34/35 patients. 73% noticed a significant improvement or disappearance of dystonia and pain following surgery and physiotherapy for 3 months postoperatively. Selective peripheral denervation is recommended for patients with spasmodic torticollis of at least 1-2 years duration which is resistant to conservative treatment. It may also be used in patients who do not respond to injection of botulinum A toxin or who develop resistance to this kind of therapy.

Follow-Up Studies↗
PubMed1993

Effectiveness of botulinum toxin in the treatment of spasmodic torticollis.

Thirty-two patients with spasmodic torticollis were assessed quantitatively for posture deformity, tremor and range of neck movement, and qualitatively for pain and global subjective disability. All patients were then treated with intramuscular botulinum toxin injections into appropriate neck muscles. Fifty-three treatments were administered using dosages of toxin in the range of 50-100 U per muscle. The maximum dose administered at a single sitting was 280 U. The progress of the patients was assessed during an 18-month period. Seventy-five percent of patients showed documented improvement in both subjective and objective parameters and were considered treatment successes. Pain improved in 65%, posture in 65%, tremor in 50% and range in 46%. The side effects that occurred were transient and included fatigue, dysphagia, neck weakness, hoarseness and local pain. This study demonstrates that treatment with botulinum toxin is of significant benefit for the majority of patients with spasmodic torticollis.

Adult↗
PubMed1982

Torticollis as the presenting sign in cervical spine infection and tumor.

This report presents five patients with cervical-area infection and four with spinal cord tumors who presented with torticollis early in the course of their illnesses. three children were found to have osteomyelitis of the cervical spine; two, retropharyngeal abscess; two, intramedullary astrocytoma; one, extradural neuroblastoma; and one, extradural sarcoma. Though torticollis is most frequently a benign condition, its persistence or its association with other objective findings should lead to search for an etiologic basis.

Abscess↗
PubMed1984

Benign paroxysmal torticollis in infancy.

We present four children with benign paroxysmal torticollis (BPT) and a review of the literature. BPT appears to be a self-limited disorder that occurs predominantly in females. The attacks of head tilting usually start in infancy, may recur at varying intervals until the age of 1 to 5 years, and may be confused with other seizures. Other symptoms, such as ataxia and vomiting, may be associated with the attacks of torticollis. Less frequently, infantile migraine also may be associated.

Ataxia↗
PubMed1991

Low dose botulinum toxin in spasmodic torticollis.

Botulinum toxin has been successfully used to treat spasmodic torticollis. The optimum dosage is not clear and the recommended doses in the United Kingdom are 20-25 ng. We have used much lower doses (average 13 ng) without loss of efficacy and accompanied by a reduction in side effects. We treated 12 patients (eight women and four men) with a mean duration of torticollis of 4 years. Eleven of the 12 patients (91%) showed an improvement in total scores for pain and degree of head movement. The benefits appeared a week after treatment and lasted for 3 months. Side effects were minimal and transient. Our experience suggests low doses of the toxin may be equally efficacious.

Adult↗
PubMed1984

Spasmodic torticollis as a cause of ulnar nerve entrapment.

Spasmodic torticollis is thought to be a central nervous system disorder with no peripheral nervous system component. Several consecutive patients with spastic torticollis were found to have ulnar nerve compromise at the elbow on the side ipsilateral to the direction of chin turning. This article describes three such patients in detail. It is postulated that the cause is the stereotypical posture assumed by these patients in using their hand to maintain a neutral head position. The chronic leaning and elbow flexion place the ulnar nerve at risk for the development of pressure neuropathy.

Adult↗