ABSTRACT
Professor WU Lian-zhong's experience in treating spasmodic torticollis by Kaiqiao Shunjin method (resuscitation and regulating muscle) is summarized in this paper. The pathogenesis of spasmodic torticollis is the occluded brain orifices and delirium, qi disorder of meridian tendons, specifically divided into five categories: damp-heat, liver-yang hyperactivity, liver-kidney yin deficiency, deficiency of the governor vessel, excess of the governor vessel. The treatment should be based on the symptoms and the root causes, the symptoms should be the main treatment, and the root cause should be treated based on syndrome differentiation. The main treatment is Kaiqiao Shunjin method (resuscitation and regulating muscle), and to take the chief (five heart acupoints-Shuigou [GV 26], Laogong [PC 8], Yongquan [KI 1]), deputy (Yintang [GV 24+], Shangxing [GV 23] through Baihui [GV 20], Ximen [PC 4]), assistant (Fenglong [ST 40], Lianquan [CV 23], combined with tongue needle prick), envoy (Hanyan [GB 4]) as the basic main acupoints, at the same time cooperate with local acupoints to remove knots and accumulation. Finally, syndrome differentiation is adopted to dredge meridians and disperse knots, regulate the governor vessel, and nourish yin and dispel wind.
Subject(s)
Humans , Acupuncture Points , Acupuncture Therapy/history , Meridians , Needles , Syndrome , Torticollis/therapyABSTRACT
The thinking and experience of professor
Subject(s)
Humans , Acupuncture Points , Acupuncture Therapy , Meridians , Moxibustion , Torticollis/therapyABSTRACT
@#<p><strong>OBJECTIVE: </strong>To discuss a case of congenital muscular torticollis and its presentation, pathophysiology and management. </p><p><strong>METHODS: </strong></p><p> <strong>Design: </strong>Case Report</p><p> <strong>Setting: </strong>Tertiary Private Hospital</p><p> <strong>Patient: </strong>One</p><p><strong>RESULTS: </strong>An 11-year-old girl presented with tilting of head to the right and progressive limitation of head movement since infancy. MRI showed a shortened right sternocleidomastoid muscle. The patient underwent surgical release of torticollis. Full range of motion of the neck was achieved after the surgical management.</p><p><strong>CONCLUSION</strong>: Congenital torticollis is a rare condition of the head and neck region. Physicians should be familiar with this entity and its presentation and it should be considered in the differential diagnosis of patients with progressive limitation of head movement in order to initiate early treatment and avoid progressive physical deformity.</p><p> </p><p><strong>KEYWORDS: </strong>congenital muscular torticollis; familial spasmodic torticollis</p>
Subject(s)
Humans , Female , TorticollisABSTRACT
Professor ' clinical experience in the treatment of primary cervical dystonia based on the syndrome differentiation of TCM was explored preliminarily. Based on the disease identification of western medicine and the syndrome differentiation of TCM, in combination with the differentiations of meridians and collaterals of acupuncture, Professor proposes the three-dimensional system of diagnosis and treatment of acupuncture, named "disease differentiation, TCM syndrome differentiation and meridian differentiation". Regarding the diagnosis and treatment of primary cervical dystonia, the physical examination of nerve system, TCM syndrome differentiation and meridian differentiation are equally important. It is pointed out that the key pathogenesis of the disease is and blood obstruction and the malnutrition in the muscle regions of meridians. Hence, the treating principle is proposed as eliminating the exogenous pathogens, regulating and blood and unblocking the muscle regions of meridians. Professor also stresses that the affected sites and the factors of dystonia should be considered in acupuncture treatment. The local points are mainly those adjacent to the responsible muscles with the motor disturbance in the neck region. "Xinshe" point (Extra) is taken as the empirical point. The distal points are selected in accordance with the three-dimensional system of diagnosis and treatment. At the same time, the percutaneous acupoint electric stimulation is applied to the starting and ending points or the conjunctive points of the affected muscles, acting on regulating , nourishing blood and promoting the circulation in meridians and collaterals.
Subject(s)
Humans , Acupuncture Therapy , Meridians , TorticollisABSTRACT
Objective To investigate the characteristic of movement disorders,so as to improve their diagnosis and treatment. Methods The clini?cal data of patients with movement disorders that admitted in the dystonia and Botox outpatient department were analyzed. Results Cases of involun?tary movement were significantly more than the primary dystonia,and case of primary hemifacial spasm was dominant(163 cases,61.05%). Among the 66 cases of primary dystonia,blepharospasm was ranked the first(19 cases),the second was spasmodic torticollis(18 cases),and the third was Meige syndrome(12 cases).There was no statistical significance in the gender distribution among primary hemifacial spasm,blepharospasm,spas?modic torticollis and Meige syndrome. Instead,there was statistical significance in the treatment methods(P<0.05),and there was statistical signifi?cance in the mean treatment and onset age(P<0.05). Of the 163 cases with primary hemifacial spasm,the mean onset age was 44.22±12.22 years, and the ratio of men to women was 1∶2.4. There were statistical significances in the mean onset age and duration among the patients with different severity degrees(all P<0.05). Conclusion Primary hemifacial spasm,blepharospasm,spasmodic torticollis and Meige syndrome are the com?mon disease in outpatient department. The primary hemifacial spasm is dominant,women are more than men,and the onset age and/or duration are proportional to the severity degree.
ABSTRACT
Objective To investigate the clinical efficacy of combined use of acupuncture and medicine in treating spasmodic torticollis.Method Thirty patients were randomly allocated to a treatment group of 15 cases and a control group of 15 cases. The treatment group received combined use of acupuncture and medicine, and the control group, acupuncture alone.Result Clinical observation lasted one year. There was a statistically significant pre-/post-treatment difference in the Tsui score in the two groups at 6 and 12 months after treatment (P<0.01). There was a statistically significant difference in the Tsui score between at 6 and 12 months after treatment in the two groups (P<0.01); the Tsui score decreased gradually after treatment. There was a statistically significant post-treatment difference in the Tsui score between the two groups at 12 months after treatment (P<0.05); the Tsui score decreased more in the treatment group.Conclusion The cure and marked efficacy rate of combined use of acupuncture and medicine for spasmodic torticollis is higher than that of acupuncture alone. A longer course is needed for acupuncture treatment of spasmodic torticollis and the patient should persevere with the treatment.
ABSTRACT
Objective To observe the impact of an injection of botulinum toxin type A combined with rehabilitation on the quality of life (QOL) of patients with spasmodic torticollis.Methods Thirty-eight patients with spasmodic torticollis were randomly divided into a combined treatment group and control group.Both groups were given a local muscular injection of botulinum toxin type A.One week later the combined group was given rehabilitation training.Both groups were assessed using the Toronto torticollis rating scale (TWSTRS),Tsui's scale and a health survey (SF-36) one week and eight weeks after the injection.Results Eight weeks after the injection,severity,disability,pain,physical functioning,vitality,mental health and Tsui scores had all increased significantly in the combined treatment group compared with before treatment.Physical functioning,pain,vitality,mental health and Tsui scores had also improved significantly compared with the control group.In the control group,only severity and Tsui scores were significantly improved compared with before treatment.Throughout the course of treatment there were no significant adverse reactions.Conclusions Combining botulinum toxin type A with rehabilitation has synergistic effects on spasmodic torticollis.It can significantly reduce disability scores,relieve pain and improve quality of life.
ABSTRACT
Objective To study the perioperative nursing care of minimally invasive operation in the neurosurgical treatment of laterial flexure spasmodic torticollis (LaFST).Methods Minimally invasive operation was used to treat LaFST.The relationship of inducing factors and emotional factors with clinical manifestation of LaFST was investigated.To give perioperative psychological nursing,operation nursing and rehabilitation training and instruction.Results 72 cases were recovered (81.8％) among 88 cases.12 cases(13.6％) were markedly effective.4 cases(4.6％) showed progress.Conclusions The minimally invasive surgical treatrnent of selective resection of cervical spasmodic muscles and selective neurotomy of cervical nerve for LaFST is safe and effective.Strengthening of perioperative nursing and postoperative rehabilitation instruction is very important for patients' early recovery.
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Objective To observe the influence of secondary spasmodic torticollis on the balance of hemiplegic stroke survivors and to compare the effects of different treatment protocols.Methods Fifty-six secondary spasmodic torticollis patients after stroke were randomly divided into three groups based on the type of treatment.The botulinum toxin (BTX) group received BTX-A injections and common support treatment plus rehabilitation training (n =19),the medication therapy group received oral baclofen and common support treatment plus rehabilitation training (n =18),and the routine rehabilitation group received only routine rehabilitation therapy (n =19).In addition,19 stroke cases without spasmodic torticollis served as a control group.They also were treated with routine rehabilitative treatment alone.Before and after 2 months of treatment,balance was assessed using Berg's balance scale,and spasmodic torticollis was evaluated using Tsui's scale.Results Before treatment the balance of the control group members was significantly better than that of the other three groups.After 2 months of therapy,balance function had improved significantly in all four groups.The balance of the botulinum toxin group was better than that of the medication and routine rehabilitation groups.After treatment,Tsui scale scores in the medication and botulinum toxin groups were significantly lower than before treatment,and the scores in the botulinum toxin group were significantly lower than in the medication and routine rehabilitation groups.There was no significant difference in Tsui scale scores before and after treatment in the control group.Conclusions Spasmodic torticollis inflaences the recovery of balance function in hemiplegic patients after stroke.Treating the spasmodic torticollis can improve their balance.Treatment with BTX-A combined with common support treatmcnt and rehabilitation training showed significant curativeeffect.
ABSTRACT
OBJECTIVE: The purpose of this study was to evaluate quality of life (QoL) in a Brazilian population of individuals with cervical dystonia (CD) without effect of botulinum toxin (BTx) or with only residual effect of BTx, and identify possible physical and social aspects that affect their QoL. METHOD: Sixty five out of sixty seven consecutive patients with CD were assessed with two instruments: Short-form Health Survey with 36 questions (SF-36) and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). RESULTS: Severity of CD (TWSTRS) correlated moderately with two SF-36 subscale: role-physical (r= -0.42) and body pain (r= -0.43). Women also scored worse in two subscale of SF-36: vitality (p<0.05) and mental-health (p<0.005). CONCLUSION: Severity of CD and gender (female) were the main factors related to a worse QoL perception. These findings may help health professionals to predict which characteristics could lead to worse QoL, and therefore, better target their interventions to lessen the burden caused by CD.
OBJETIVO: O objetivo deste estudo foi avaliar a qualidade de vida (QV) em uma população brasileira de indivíduos com distonia cervical (DC), que estavam sem o efeito da toxina botulínica ou com efeito residual da mesma, e identificar os possíveis aspectos físicos e sociais que afetam sua QV. MÉTODO: Sessenta e cinco de sessenta e sete pacientes consecutivos com DC foram avaliados com dois instrumentos: Short-form Health Survey com 36 questões (SF-36) e Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). RESULTADOS: A gravidade da DC (TWSTRS) correlacionou-se moderadamente com duas sub-escalas da SF-36: aspectos físicos (r= -0,42) e dor (r= -0,43). Mulheres apresentaram piores pontuações em duas sub-escalas da SF-36: vitalidade (p<0,05) e saúde mental (p<0,005). CONCLUSÃO: Gravidade da DC e gênero (feminino) foram os principais fatores relacionados à pior percepção de QV. Estes achados podem auxiliar profissionais da saúde a identificarem quais características poderiam levar a uma pior QV, e assim direcionar melhor suas intervenções, atenuando os danos causados pela DC.
Subject(s)
Female , Humans , Male , Middle Aged , Botulinum Toxins/therapeutic use , Neuromuscular Agents/therapeutic use , Quality of Life/psychology , Torticollis/drug therapy , Botulinum Toxins, Type A , Drug Residues , Educational Status , Severity of Illness Index , Sex Factors , Treatment Outcome , Torticollis/psychologyABSTRACT
We studied contemporary indication of daikankyoto and daikankyoganryo. We administered either of these Kampo prescriptions for thirty-three patients with intractable muscle stiffness of neck, shoulder and back.Twenty-four patients were able to take the prescriptions for more than four weeks (long term group), and nine patients stopped taking the prescriptions less than four weeks (interrupted group). In long term group, fourteen patients (58%) improved their chief compliant. The Kampo formulations of fourteen effective cases were daikankyoto (13 cases) and daikankyoganryo (1 case). Comparative analysis has been done between long term group and nine cases of interrupted group. The characteristics of long term group were higher body mass index, firmer abdomen and more positive cases of epigastric resistance sign. Kansui root dose was 0.81 gram a day in long term group and 0.57 gram a day in interrupted group, which showed statistically-significant difference. We found twenty-seven side-effects in twenty four patients (73%) including eighteen patients with nausea and six patients with diarrhea. In side effects, there was no statistically significant difference between two groups. These side effects were promptly improved after discontinuation or dose reduction of Kansui root. We report clinical courses of six improved cases in this paper, two severe stiff neck, shoulder and back cases, each one case of psychosomatic disorder, depression, spasmodic torticollis and gastroesophageal reflux. These prescriptions should be administered more commonly to the patients with severe stiff neck, shoulder and back.
ABSTRACT
We report here on a case of right side spasmodic torticollis (ST) that was refractory to botulinum toxin type A injection and medication.The patient finally underwent a selective ramisectomy with ipsilateral sternocleidomastoid muscle (SCM) resection, but the remaining symptoms slowly aggravated, and a contralateral left side SCM spasm began.As conservative therapy for reducing the spasmodic symptoms, accessory nerve block, upper cervical plexus block and stellate ganglion block were performed twice in a week.After 6 months, the spasmodic symptoms significantly decreased. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) decreased by more than 70%.After one year of serial intermittent local anesthetic blockade therapy, the patient became almost free from the original ST symptoms (TWSTRS = 1).Serial local anesthetic interventions for the ST patient may have a beneficial role on the pathological peripherocentral neural activity of the ST patient and can modulate motor-sensory integration in the patient.
Subject(s)
Humans , Accessory Nerve , Botulinum Toxins, Type A , Cervical Plexus , Nerve Block , Spasm , Stellate Ganglion , TorticollisABSTRACT
Cervical dystonia is the most common form of local dystonia encountered in a movement disorders clinic. Rotatocollis is involuntary contraction of sternocleidomastoid and contralateral splenius muscles resulting in twisting of the head clockwise or counterclockwise on the axial plane. We injected phenol solution into the affeced muscle or nerve branch in two patients with rotatocollis. There was significant improvement in neck movement and position. Phenol block may offer an easy and inexpensive alternatives for patients with cervical dystonia.
Subject(s)
Humans , Dystonia , Head , Movement Disorders , Muscles , Neck , Paraspinal Muscles , Phenol , TorticollisABSTRACT
OBJECTIVE: The Bertrand's method of selective peripheral denervation for spasmodic torticollis has already been established as being an effective and safe method. However, such effectiveness has not yet been established in Korea. The authors have performed several cases of selective denervation for the treatment of spasmodic torticollis and we hereby describe the details of the operative method to determine the effectiveness of the method. METHODS: Ten patients who had the selective denervation for the spasmodic torticollis from October 1997 to December 2003, were analyzed. There were 4 rotational and 6 combined types (3 rotational plus retrocollis, 3 rotational plus laterocollis). We performed preoperative electromyograms and neck muscle tonograms in all cases. The technique was used to involve denervation of the ipsilateral posterior paraspinal muscles. Denervation of the sternocleidomastoid muscle was performed on the contralateral side for rotational torticollis and on the ipsilateral side for laterocollis combined type. The surgery was followed by a rigorous physical therapy program. RESULTS: The surgical results were divided into 4 groups labeled excellent, good, fair, and poor. There were 5 excellent patients who showed no detectable abnormal movements, 4 good patients who showed slight residual deviations or slight residual abnormal movements, and 1 fair patient with appreciable residual abnormal movements. Postoperative pain was well tolerated. There was no significant surgical complications. CONCLUSION: The study confirms that selective peripheral denervation for the treatment of spasmodic torticollis is a very useful and safe surgical technique.
Subject(s)
Humans , Denervation , Dyskinesias , Korea , Neck Muscles , Pain, Postoperative , Paraspinal Muscles , TorticollisABSTRACT
OBJECTIVE: Various methods of treatment for idiopathic cervical dystonia have been tried in the past with unsatisfactory results. The authors report cases of five patients who underwent selective peripheral denervation for spasmodic torticollis. METHODS: Between July 2002 and December 2003, 5 patients underwent surgery at St. Mary's Hospital for spasmodic torticollis. Age of the patient at the onset of symptoms ranged from 29 to 56years (mean 43.75years). Selective peripheral denervation(SPD) was performed at 7 to 11months after the onset of symptoms (mean 8.75 months). A patient was considered to be the candidate for surgery if conservative methods were unsuccessful and symptoms persisted for longer than 7months. In addition, 2patients who refused treatment with botulinum toxin were also enrolled in this study. RESULTS: Although one patient underwent reoperation, all of the five patients' symptoms were improved after the operation. Clinically, patients with retrocollis showed better improvement than laterocollis patients. CONCLUSION: Although injection of botulinum toxin is the first-choice in treatment modality, when surgery is required, selective peripheral denervation provides good results with minimum side effects.
Subject(s)
Humans , Botulinum Toxins , Denervation , Reoperation , TorticollisABSTRACT
Botulinum toxin type A(BTA) is well known treatment agent in the treatment of paralytic strabismus in ophthalmological field for more than 15 years. Its therapeutic potential as temporary paralyzing agent was adopted to treat several neurologic, movement disorders. In recent years, BTA is considered as initial medical treatment option in such as blepharospasm, hemifacial spasm, spasmodic torticollis, spasmodic dysphonia. Authors applied BTA injection in cases with spasmosmodic torticollis, hemifacial spasm, facial synkinesis and experienced staisfactory result. So authors present our experience of BTA injection therapy and discuss techniques, advantages and disavantages.
Subject(s)
Blepharospasm , Botulinum Toxins , Botulinum Toxins, Type A , Dysphonia , Dystonia , Hemifacial Spasm , Movement Disorders , Strabismus , Synkinesis , TorticollisABSTRACT
To determine the effects and its complications of ventral cervical and selective spinal accessory nerve rhizotomy in the spasmodic torticollis, 14 patients who had undergone surgery between 1989 and 1997 were reviewed retrospectively. In overall twenty four operations were performed. The ventral cervical rhizotomy with spinal accessory nerve rhizotomy were performed in nine patients and the ventral cervical rhizotomy without spinal accessory nerve rhizotomy were done in two patients. Five cases of sternocleidomastoid myotomy with or without peripheral accessory neurectomy, and the five cases of peripheral accessory neurectomy were also performed. In two patients, the selective peripheral denervations were performed. In overall thirteen patients(93%) showed improvement in their condition. Of the eleven patients with the ventral cervical rhizotomy and spinal accessory nerve rhizotomy, nine patients(82%) improved. Five patients suffered from dysphagia or dysphonia postoperatively for several months, but one patient is having more than two years. Of these six patients, five patients had undergone the bilateral upper cervical rhizotomy and bilateral accessory nerve rhizotomy. Therefore to reduce the postoperative dysphagia or dysphonia, the authors recommend to save the unilateral cervical ventral roots or unilateral accessory nerve root. The authors also stress that the selective peripheral denervation would be the choice of operation in cases with the spasmodic torticollis because of its effectiveness and rarity of complications.
Subject(s)
Humans , Accessory Nerve , Deglutition Disorders , Denervation , Dysphonia , Retrospective Studies , Rhizotomy , Spinal Nerve Roots , TorticollisABSTRACT
As one of the various surgical procedures for the spasmodic torticollis the author performed bilateral C1, 2, 3 ventral rhizotomy and unilateral selective spinal accessory nerve section in 4 patients with disabling torticollis, The patients consisted of 3 men and 1 woman with symptom duration of 1 to 3 years. The surgical outcome was excellent in 2, markedly improved in 1 and slightly improved in 1. Postoperative complications were shoulder weakness, transient leg weakness, voiding difficulty and mild weakness of neck movement.
Subject(s)
Female , Humans , Male , Accessory Nerve , Leg , Neck , Postoperative Complications , Rhizotomy , Shoulder , TorticollisABSTRACT
A case of spasmodic torticollis in a 48-year-old man cured by micovascular decompression of the spinal accessory nerve with selective dorsal cervical rhizotomy of the first and second cervical nerves. The 11th nerve was compressed by the posterior inferior cerebellar artery originating from the vertebral artery at the C1 level. After intraoperative identification of each posterior rootlets of C1 and C2 nerves exclusively related with the involved sternocleidomastoid muscle(SCM) using the monopolar electric nerve stimulator, microvascular decompression with selective dorsal cervical rhizotomy was done using the Teflon felt and electrobipolar coagulator. The patient was significantly relieved from symptoms 1 week after operation.
Subject(s)
Humans , Middle Aged , Accessory Nerve , Arteries , Decompression , Microvascular Decompression Surgery , Polytetrafluoroethylene , Rhizotomy , Torticollis , Vertebral ArteryABSTRACT
The exact pathophysiologic mechanisms of spasmodic torticollis and other idiopathic torsion dystonias remain largely 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 anticholinergics, benzodiazepines, dopaminergics and dopamine antagonists with variable degrees of clinical improvement. Botulinum toxin A injection treatment for spasmodic torticollis is safe and efficacious with minimal adverse effect. However, it is expensive and beneficial effects are short-lasting. Only when a spasmodic torticollis patient's symptoms are refractory to combined treatment, using various drugs and Botulinum toxin injections, should the patient be considered a candidate for neurosurgical procedures.