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PubMed1992

Failure of buspirone and verapamil to improve spasmodic torticollis.

The effects of buspirone and verapamil on spasmodic torticollis were investigated in two double-blind, placebo-controlled crossover studies. Buspirone was given in doses of 20-100 mg/day for 4 weeks to 14 patients; verapamil was given in doses of 40-100 mg/day for 3 weeks to 8 patients. Neither drug improved symptoms of the movement disorder (posture, motility, rigidity, tremor), pain, perceived stress, or mood, either in the whole group or in any individual patient.

Adult↗
PubMed1994

Use of botulinum toxin injections for spasmodic torticollis of tardive dystonia.

Because intramuscular injections of type A botulinum toxin (btx) are effective for idiopathic spasmodic torticollis, they were administered to 3 patients who had neck movements as their only manifestation of tardive dystonia. Each improved, with a decrease in involuntary movement and reduction in pain. None had either systemic or local side effects. Although expensive, btx treatment is recommended for involuntary neck movements of tardive dystonia but not yet for the classic buccolingual dyskinesia.

Adult↗
PubMed1988

Brain imaging and treatment response in spasmodic torticollis.

A patient with spasms of the neck, occurring when he turned his head to the left, responded to treatment with benzhexol. Cerebral blood flow imaging demonstrated reduced uptake in the right corpus striatum compared with the left. The study demonstrates the presence of an abnormality in the basal ganglia; it also illustrates response to drug treatment. Cerebral blood flow imaging may be useful in the detection of basal ganglia abnormalities in spasmodic torticollis and assist in the selection of cases which should be targeted for treatment with drugs.

Adult↗
PubMed1977

Treatment of spasmodic torticollis with amantadine: a double-blind study.

Ten patients with spasmodic torticollis participated in a double-blind crossover trial of amantadine hydrochloride for a period of 2 months each. A further regimen of combined amantadine and haloperidol was tried with three patients after the conclusion of the double-blind trial. There were no therapeutic benefits of either treatment. Half of the patients reported minor side effects that resolved promptly when amantadine was discontinued.

Adult↗
PubMed1983

Acute infectious torticollis.

Acute torticollis has occurred in epidemics in eastern and northern China since 1975, but has not yet been reported in other countries. A general account of this disease, including its terminology, epidemiology, clinical features, laboratory findings, diagnosis, differential diagnosis, and treatment, is presented. The etiology, though highly suggestive of a virus infection, remains to be determined.

Acute Disease↗
PubMed1986

Spontaneous remissions in spasmodic torticollis.

We reviewed the frequency of spontaneous remissions in spasmodic torticollis (ST). One hundred sixteen patients with idiopathic ST (72 F, 44 M) were examined. The age at onset ranged from 9 to 69 (mean, 38.1 +/- 1.3). Twenty-one patients (18%) were Jewish. Eleven patients (9%) had a history of familial dystonia. Remissions longer than 1 year unrelated to treatment were observed in 14 patients (12%) (9 F, 5 M). They occurred in the first year of ST in 13 patients (93%) and in the eighth year in 1. Duration of remissions ranged from 1 to 20 years (mean, 6.5 +/- 1.6). Two patients had three remissions, and another had two. The mean age at the onset of ST in patients with remission was 26.4 +/- 3.3 (SEM) and ranged from 9 to 49. The age at the onset in the patients without remissions was 39.7 +/- 1.4, ranging from 10 to 69 (p less than 0.01). In the remission group, 3 patients were Jewish (21%); in the non-remission group, 18 (18%) were Jewish. There was a familial history in 1 case with remission (7%) and in 10 cases (10%) without remission. Spontaneous remissions in the course of ST seem to be more frequent in patients with early onset, and they occur usually during the first year.

Adolescent↗
PubMed1986

PET studies of cerebral glucose metabolism in idiopathic torticollis.

Regional cerebral glucose metabolism was studied in 16 patients with idiopathic torticollis, using positron emission tomography. Analysis of subcortical regions revealed no consistent focal abnormality of cerebral metabolic rate for glucose, but there was a bilateral breakdown of the normal relationships between the thalamus and basal ganglia. The findings suggest disruption of the pallidothalamic projections in this focal dystonia and may imply a disturbance of GABA.

Adult↗
PubMed1988

The clinical course of spasmodic torticollis.

Among 24 of 36 patients with idiopathic spasmodic torticollis referred to one of us over a 10-year period, who were followed up for more than 1 year, we defined three outcome groups. Three patients (13%) underwent complete or almost complete remission at a median of 3.0 years into the illness. Eight patients (33%) had partial remissions, which tended to occur somewhat later than the first group. The remaining 13 patients had no significant improvement in their disease; they were more likely to be older at the onset of the illness, develop constant rather than intermittent neck deviation, and have a "geste antagonistique." As a whole, the study population was exposed to a wide variety of therapeutic interventions that had little, if any, obvious clinical effect.

Adolescent↗
PubMed1989

Controlled trial of botulinum toxin injections in the treatment of spasmodic torticollis.

We administered local injections of botulinum toxin to 20 patients with torticollis in a blinded, placebo-controlled study. Each patient received four sets of injections: three different doses of botulinum toxin and one placebo. The order of the sessions was random and unknown to the patients. Sixteen of the patients (80%) reported subjective improvement to at least one dose of botulinum toxin; 11 (55%) reported substantial improvement. No objective benefit was documented. Side effects were minor and transient, although dysphagia occurred in four. Some patients reported that the effect waned despite persistent relaxation or even flaccidity of previously overactive muscles, suggesting a change in the pattern of muscle activity after botulinum toxin injections.

Adult↗
PubMed1990

Swallowing function in patients with spasmodic torticollis.

We examined the oropharyngeal swallowing ability of 43 patients with spasmodic torticollis using a videofluoroscopic procedure. Twenty-two (51.2%) demonstrated objective evidence of swallowing abnormalities; 15 (34.9%) had subjective complaints. Delayed swallowing reflex and vallecular residue were more frequent (p less than 0.0046) than any other abnormality. The constellations of abnormalities were consistent with neurogenic, postural, and mixed neurogenic-postural types of dysphagia.

Adult↗
PubMed1992

Botulinum toxin injection for spasmodic torticollis: increased magnitude of benefit with electromyographic assistance.

To determine the usefulness of EMG-assisted botulinum toxin (BOTOX) injections for the treatment of spasmodic torticollis (ST), we randomized 52 ST patients into two groups and studied them prospectively. In one group [(E+C)RX, N = 28], the muscles were selected for BOTOX injection using both clinical and EMG examination and then injected with EMG assistance. In the second group [(C)RX, N = 24] the muscles were selected for BOTOX injection based solely on clinical examination and injected without EMG assistance. The percentage of patients showing any improvement after BOTOX as similar in both the (E+C)RX and (C)RX groups. A significantly greater magnitude of improvement was present in the (E+C)RX group, as well as a significantly greater number of patients with marked improvement. In particular, patients with retrocollis, head tilt, and shoulder elevation demonstrated additional benefit with EMG-assisted BOTOX injection. EMG assistance may be effective because the technique increases the ability to effectively identify and treat the deep cervical muscles.

Adult↗
PubMed1992

Dysphagia after botulinum toxin injections for spasmodic torticollis: clinical and radiologic findings.

We prospectively evaluated the frequency, severity, and radiologic features of swallowing abnormalities following Botox treatment of spasmodic torticollis. We performed both clinical and radiologic evaluations of swallowing before and following Botox in 18 consecutive cervical dystonia patients receiving their first Botox treatment. Before Botox, 11% of the patients had clinical symptoms of dysphagia and 22% had radiologic signs of a peristaltic abnormality. After Botox, the signs and symptoms of dysphagia in these patients did not change, but an additional 33% developed new dysphagic symptoms and 50% of the patients developed new peristaltic abnormalities by radiologic studies. Complaints of swallowing difficulty were always associated with abnormal radiologic findings. Neither the total Botox dose nor Botox into particular muscles differed between those with dysphagia and those without.

Adult↗
PubMed1994

Prolonged MRI T2 times of the lentiform nucleus in idiopathic spasmodic torticollis.

Using high-field MRI, we investigated possible morphologic changes in the basal ganglia of 22 patients with clinically diagnosed idiopathic spasmodic torticollis (iTs) compared with 28 age-matched normal controls. Two patients were found to have distinct basal ganglia lesions and were excluded from further analysis. The frequency of gross morphologic changes (atrophy, enlarged Virchow-Robin spaces) in patients was not significantly higher than in controls. However, T2 values calculated for the putamen and pallidum on both sides were significantly higher in the lentiform nucleus of the patients compared with the controls. In contrast, other well-defined subcortical regions did not exhibit a similar abnormality, nor did the optical or quantified signal analysis of various regions of interest show any differences. This finding suggests a morphologic abnormality in iTs that is not associated with a gross structural lesion. It could reflect focal gliosis and might correspond to earlier sporadic pathoanatomic descriptions of gliosis in idiopathic dystonia.

Adult↗
PubMed1994

Clozapine treatment of spasmodic torticollis.

We report a trial of clozapine (CLO) in patients with spasmodic torticollis (ST). In an open-design trial we treated five patients with adult-onset ST with CLO (300 mg/d) over 12 weeks and one patient over 3 weeks. We videotaped the patients three times (before and at the end of CLO treatment, and 2 weeks after CLO withdrawal) according to a standardized protocol. At the end of the treatment period, CLO plasma concentrations ranged from 67 to 371 ng/ml. In all six patients, analysis of the video ratings and patients' self-assessments failed to reveal any improvement of ST. These preliminary results fail to confirm any therapeutic benefit of CLO in the treatment of ST.

Adult↗
PubMed1997

Torsional eye movements in patients with skew deviation and spasmodic torticollis: responses to static and dynamic head roll.

We measured torsional eye movements induced by sinusoidal rotation or static tilt, of the head in roll while viewing a far or near target in 4 patients with skew deviation due to brainstem lesions, 4 patients with spasmodic torticollis (ST), 2 patients with unilateral eighth nerve section (VIIIS), and 10 normal subjects. Torsional nystagmus was present in all 4 patients with skew deviation. In subjects and patients, responses to both sinusoidal and static roll were larger while viewing the far target, consistent with factors dictated by geometry. Response gains to sinusoidal roll were abnormal in 3 patients with skew (increased in one, decreased in two), abnormal in 3 with ST (increased in 1, decreased in 2), and in abnormal both VIIIS patients (decreased). Greater abnormalities were evident in 3 skew patients while rolling away from the side of their brainstem lesions and in both VIIIS patients while rolling toward their lesioned ears. There were similar but less pronounced changes during static head roll. We conclude that patients with skew, ST, and VIIIS may all have abnormal ocular counter-rolling that is more evident during dynamic testing while viewing a far target. Such abnormalities endure because of the limited influence exerted by vision on torsional eye movements.

Adult↗
PubMed1994

Selective peripheral denervation for the treatment of spasmodic torticollis.

The results of selective peripheral denervation in 50 patients with spasmodic torticollis are presented. Of our patients, 76% reported a significant improvement or disappearance of their dystonia. The mean follow-up is 25 months. There were no major side effects. We recommend the procedure to patients who primarily have responded to botulinum toxin therapy and had become secondary nonresponders or to those refusing further injections while still responding. The results are much less promising in patients who are primary nonresponders to botulinum toxin. Some remarkable histological findings are presented. The posterior branches of the cervical roots frequently showed signs of severe compression neuropathy. In three cases, a functional motor nerve regeneration was proved. Among all surgical options, selective peripheral denervation provides the best result and has the fewest side effects.

Adolescent↗
PubMed2001

Evaluation of persistent torticollis following adenoidectomy.

Post-operative neck complaints are not an uncommon finding following adenotonsillectomy. However, non-traumatic subluxation of the atlantoaxial joint (Grisel's syndrome) should be considered in cases of persistent neck pain and stiffness. An early diagnosis and adequate treatment of this rare condition is mandatory to prevent potentially serious complications. We describe three cases with persistent torticollis in the post-operative period, discuss the pathogenesis and evaluate the clinical management of these patients.

Adenoidectomy↗
PubMed1993

Therapeutic effects of flunitrazepam in dystonias and torticollis. Preliminary communication.

A new form of clinical treatment is proposed for dystonias and torticollis using flunitrazepam (FN), a powerful agonist of all benzodiazepine receptors of GABA neurons. FN has a specific effect in dystonic patients, specially those in which the hypnotic effect of this drug is absent or diminished, thus suggesting the existence of two different neurochemical categories of dystonias.

Dystonia↗