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PubMedDate not supplied

Ultrastructure of the sternocleidomastoid muscle in muscular torticollis.

The sternocleidomastoid muscles from five children with muscular torticollis--examined by transmission electron microscopy, exhibited a marked increase in interstitial collagen deposition, and scattered areas of amorphous ground substance with electron dense deposits. No vascular abnormalities were observed. Ultrastructural muscle abnormalities showed various stages of immobilization degeneration including nearly complete loss of myofibrils. The muscle abnormalities ultrastructurally are consistent with immobilization degeneration, probably secondary to the marked fibrosis in the sternocleidomastoid muscle.

Adolescent↗
PubMedDate not supplied

My battle with spasmodic torticollis: a healing experience.

The life-transforming experience of overcoming spasmodic torticollis compelled the author to write the following personal account. The author, who triumphed over this debilitating disease, is now an advocate of holistic nursing practices that motivate patients through a genuine concern for patient well-being, community, and humanity. The author describes her personal experience of grief and the grieving process; the healing effects of crying; and her selection of the complementary and alternative therapies of prayer, music, and massage that became instrumental in finding a pathway to recovery. The story has appealing implications for strategies that utilize these concepts and techniques in clinical practice.

Adaptation, Psychological↗
PubMed1999

Alexithymia and attachment representation in idiopathic spasmodic torticollis.

We investigated alexithymia and the mental representation of attachment in idiopathic spasmodic torticollis (IST). It was hypothesized a) that alexithymia in IST is more prevalent than in a nonclinical control group and b) that significant correlations emerge between alexithymia and a dismissing attachment representation. Twenty patients with IST and 20 healthy controls matched for age and sex were administered the Toronto Alexithymia Scale (TAS-20) and the Adult Attachment Interview (AAI). Attachment was classified using the Attachment Interview Q-sort. IST patients scored significantly higher on the measure of alexithymia than subjects in the comparison group. In IST a dismissing attachment representation was significantly more frequent than in the control group. Across the total sample, externally oriented thinking correlated positively with dismissing attachment, and both externally oriented thinking and difficulty communicating feelings (two of the three subscales of the TAS-20) correlated inversely with secure attachment. Alexithymia is more prevalent in IST than in normals. As was hypothesized, alexithymia in adults is significantly interrelated with the mental representation of attachment.

Adult↗
PubMed2001

Pseudotumor of infancy and congenital muscular torticollis: 170 cases.

OBJECTIVES: To review pseudotumor of infancy (POI) and congenital muscular torticollis (CMT) and to suggest an algorithm for treatment. STUDY DESIGN: Retrospective review of cases from 1962 to 1998 at a tertiary care center. METHODS: Patients included in this study were 81 boys and 89 girls who had a diagnosis of POI (n = 38) or CMT (n = 132) before 24 months of age. RESULTS: For all patients, the mean age at diagnosis was 4 months; 54.1% had the left side of the neck affected, over 90% had a head tilt, and 2.4% had feeding difficulty as a result of the disorder. Plagiocephaly was present in 39.5% of patients with POI and 63.6% of patients with CMT; a neck mass, in 63.2% and 18.2%, respectively; and facial asymmetry, in 7.9% and 15.9%, respectively. All patients had a complete physical examination; 54.1% had plain cervical radiography, 4.1%, computed tomography, and 2.9%, ultrasonography. Passive range of motion was the initial treatment recommended for 65.3% of patients. Conservative treatment failed for 16 patients; subsequently, they had surgical treatment. Follow-up data were available for 159 patients; 85.5% experienced total resolution and 14.5% experienced subtotal resolution or long-term abnormality. CONCLUSIONS: Children diagnosed with POI or CMT should be treated and observed for at least 12 months or until symptoms resolve. If symptoms persist 1 year after diagnosis despite conservative therapy, surgical treatment should be considered. The majority of children with POI or CMT experience total resolution of symptoms.

Algorithms↗
PubMed1991

Kenneth McKenzie, Harvey Cushing, and the early neurosurgical treatment of spasmodic torticollis.

In 1923, Dr. Kenneth McKenzie trained at the Peter Bent Brigham Hospital under Dr. Harvey Cushing. At that time, a patient with spasmodic torticollis came to Cushing and was treated with an innovative operation for this disorder with good results. This case sparked an interest in Dr. McKenzie, who published the case 1 year later. In reviewing the surgical histories from the Peter Bent Brigham Hospital, we have found the original records of this well-documented case. The record includes postoperative drawings of the intraoperative field by Dr. Cushing, a sketch by Dr. McKenzie illustrating the postoperative sensory examination, and pre- and postoperative photographs of the patient.

History, 20th Century↗
PubMed1991

Botulinum A toxin for the treatment of adult-onset spasmodic torticollis.

Thirty-five patients with adult-onset idiopathic torticollis were treated by local injections of botulinum A toxin into dystonic cervical muscles. Substantial improvement with respect to reduction and elimination of pain was found in 81 percent, improvement in posture deformity and involuntary spasms in 70 percent, increased range of motion of the neck in 78 percent, reduction in visible sternocleidomastoid hypertrophy in 86 percent, and improvement in tremor in 65 percent. The syndrome was divided into four subtypes based on pattern of dystonic muscle groups involved in the dystonia, head and shoulder posture, and sternocleidomastoid muscle hypertrophy. Injection strategy based on this subdivision is described.

Adult↗
PubMedDate not supplied

Alternative splinting methods for the prevention and correction of burn scar torticollis.

Significant neck burns may lead to deforming lateral flexion and rotation contractures. A two-device splinting regimen has been designed to prevent such contractures. In the acute phase, the Dynamic Antitorticollis Strap is applied while the patient is in bed to gently rotate the head and neck toward the neutral position. This dynamic strap includes a Velfoam headband attached to Thera-Band secured to the patient's bed. The antitorticollis neck splint is used in the rehabilitation phase and can be serially adjusted to correct lateral flexion contractures of the neck. Thermoplastic material is cut from a modified neck splint pattern and draped over the temporaloccipital region and anterior/posterior shoulder ipsilateral to the contracture and the anterior and contralateral aspect of the neck. The combined use of these devices during the scar maturation phase provides therapists with alternatives in preventing burn scar torticollis.

Burns↗
PubMedDate not supplied

The relationship between developmental dysplasia of the hip and congenital muscular torticollis.

Multiple studies report a correlation between congenital muscular torticollis (CMT) and developmental dysplasia of the hip (DDH) at a rate between 2% and 29%. Most of these studies were completed before the routine use of hip ultrasound. This study assesses the incidence of DDH in a referral population with CMT and the incidence of CMT in a referral population with DDH. We retrospectively reviewed 186 patients referred with a primary diagnosis of DDH and 109 patients referred with a primary diagnosis of CMT between 1995 and 2004. All patients were screened for DDH with ultrasound if they were younger than 4 months and plain radiographs in older children. Among the patients with a primary diagnosis of DDH, 5.9% were subsequently diagnosed with CMT. However, infants who were less than 1 month old when diagnosed with DDH had a 9% risk of subsequent development of CMT. Among the patients primarily diagnosed with CMT, 3.7% were subsequently diagnosed with DDH. Among the patients with DDH, there was a 7.9% coexistence of CMT, regardless of which was diagnosed first, and among the patients with CMT, there was a 12.5% coexistence of DDH. Boys with DDH were 4.97 times more likely than girls to have both DDH and CMT regardless of which diagnosis preceded the other. Our results confirm that patients with CMT should be screened for DDH, and infants, especially boys, treated for DDH should be followed for the development of CMT.

Child↗
PubMed2003

High psychiatric comorbidity in spasmodic torticollis: a controlled study.

Disturbed body image and negative self-referent cognitions caused by the postural disfigurement of the head are regarded as the main reason for elevated depression scores in spasmodic torticollis (ST), but this factor was never controlled for. We therefore compared 48 patients with ST and 48 patients with alopecia areata (AA) who were matched for age, sex, and body image dissatisfaction. Psychiatric diagnoses were based on a structured psychiatric interview (SCID-I). Results of patients with ST and AA were compared with a matched sample of the representative German population. Odds ratios to develop psychiatric comorbidity for patients with ST compared with patients with AA were significantly increased throughout nearly all assessed DSM-IV categories. Logistic regression analysis showed that (1) depressive coping and (2) belonging to the group of patients with ST correlated with a significantly higher rate of current psychiatric diagnosis. We conclude that high psychiatric comorbidity in ST is unlikely to be a mere consequence of chronic disease and disfigurement.

Alopecia Areata↗
PubMed2005

Traumatic spinal epidural hematoma-unusual cause of torticollis in a child.

Traumatic spinal epidural hematoma is rare in children. The presentation could be nonspecific, leading to a delay in diagnosis. We present an infant who sustained an epidural hematoma after a "trivial" injury. The delay in diagnosis led to minor neurological deficit at 6-week follow-up. Irritability and torticollis after a neck trauma in an afebrile child should alert to the possibility of spinal cord compression. Early imaging and early decompression will minimize morbidity.

Cervical Vertebrae↗
PubMed2005

TAMO therapy as a major component of physical therapy intervention for an infant with congenital muscular torticollis: a case report.

PURPOSE: Tscharnuter Akademie for Motor Organization (TAMO) therapy is a therapeutic approach based on dynamic theories of motor control. Research evidence supporting this approach is limited. The purpose of this case report is to describe the use of TAMO therapy in the physical therapy intervention for an infant with congenital muscular torticollis (CMT). The patient was a 4.5-month-old baby boy (corrected age) with left CMT. METHODS: Intervention included TAMO therapy, active range of motion exercise, soft tissue mobilization, and parent instruction. Changes in the amount of lateral head tilt were documented using still photography RESULTS: The infant assumed a midline head position in the supine position by the second weekly visit and maintained a midline head alignment during all functional activities by the eighth visit. CONCLUSION: This case report is the first attempt to describe a successful application of TAMO therapy as a major component of physical therapy intervention for an infant with CMT.

Exercise Movement Techniques↗
PubMedDate not supplied

An unusual case of torticollis.

A case is presented of a 9-year-old boy who developed torticollis caused by fibrosis at the site of a former ventriculoperitoneal shunt.

Child↗
PubMedDate not supplied

Results of surgical treatment of muscular torticollis for patients greater than 6 years of age.

From 1983-1989, 37 patients with muscular torticollis were treated surgically by partial resection of the distal portion of the sternocleidomastoid muscle. Of these, 19 patients who at surgery were greater than 6 years of age (average 11 years 2 months) were followed for greater than 1 year (average 2 years 2 months). Although both function and cosmesis were improved in all cases, scoliosis was a residual deformity in some cases, especially in girls.

Adolescent↗
PubMed1997

The classification of idiopathic spasmodic torticollis: three types based on social adaptation and frustration tolerance.

In this study, idiopathic spasmodic torticollis (ST) has been classfied into three types from the opinion of social adaptation and the differences of frustration tolerance. The three types were as follows: type I (overadaptive type), type II (maladaptive type), and type III (compatible type). Type I is a typical psychosomatic with high frustration tolerance. Type II is personality disorder with low frustration tolerance. In type III, frustration tolerance varies depending on social circumstances (i.e., different at home and at the office). In type I, the prognosis of ST is generally unfavorable, since it is associated with recurrence and prolongation of the symptoms. In type II, the prognosis of ST is generally favorable. However, type II patients experience relationship or social difficulties. One characteristic of type III is that the onset of symptoms is usually found in an older person because of proper use of frustration tolerance at home and at the office.

Adaptation, Psychological↗
PubMed1986

Lymphocyte subset abnormalities in patients with spasmodic torticollis.

The aetiology of spasmodic torticollis is unknown but the patients form a heterogeneous group among which are cases apparently precipitated by a viral illness and others associated with autoimmune disease. We therefore decided to investigate the immunoregulatory lymphocyte subsets in our 11 cases. A significant decrease of both helper and suppressor lymphocytes was identified in the group, together with in vitro evidence of depressed suppressor cell function. Disturbance of the immune response may play a role in this puzzling disorder.

Adult↗
PubMed1992

CT-scanning and magnetic resonance imaging in idiopathic spasmodic torticollis.

Twenty-five consecutive patients with idiopathic spasmodic torticollis (IST) were investigated with computerized tomography (CT) or magnetic resonance imaging (MRI) of the brain. In only six patients (24%) did CT or MRI reveal brain pathology (focal cortical atrophy and lacunary infarcts). No consistent pathological pattern was detected. Consequently, CT and MRI of the brain provides little diagnostic information in this disorder.

Adult↗
PubMed1996

Basal ganglia and thalamo-cortical hypermetabolism in patients with spasmodic torticollis.

UNLABELLED: The basal ganglia are thought to be involved in the primary dystonias, largely because of the repeated demonstration of neuropathological changes in these nuclei in the secondary dystonias. A hyperactivity of a network involving basal ganglia has been suggested in experimental animal dystonia. To test this hypothesis in humans, we studied the functional correlates of primary cervical dystonia using [18F]FDG and PET. MATERIAL AND METHODS: Regional cerebral glucose metabolism (rCMRglc) was measured in 10 patients with idiopathic torticollis (6 drug-free and 4 drug-naive) and in 15 normal controls, using 2-[18F]-fluoro-2-deoxy-D-glucose ([18F]FDG) and positron emission tomography (PET). RESULTS: A significant hypermetabolism in the basal ganglia, thalamus, premotor-motor cortex and cerebellum in the patients compared with normal controls was found. The patients were correctly assigned to their clinical category by a discriminant function analysis with a total accuracy of 96%. CONCLUSION: The results support the hypothesis that a dysfunction of a subcortical-cortical motor network may play a role in the pathogenesis of focal dystonia, in agreement with the experimental dystonia models.

Adult↗
PubMed1979

Benign paroxysmal torticollis in infancy.

Benign paroxysmal torticollis is a condition characterized by attacks of head-tilting often accompanied by lateral curvature of the trunc. The first onset of these attacks usually occurs during the first months of life and they recur with a remarkable periodicity for 6--12 months after which time they gradually subside in intensity and frequency. As a rule the attacks have ceased completely before the age of 2 years but in some cases they continue in a modified form as attacks of ataxia. The aetiology is unknown and there is no evidence of bilateral peripheral vestibular disturbances as has been suggested in earlier reports. The ataxia seen in some cases rather suggests a dysfunction of the cerebellum or of the vestibulo-cerebellar connections. Four own patients with this syndrome are presented and discussed.

Child, Preschool↗