Results of minimally invasive bipolar tenotomy of congenital muscular torticollis / Resultados de tenotomia bipolar minimamente invasiva de tortícolis muscular congénita

BACKGROUND: Congenital muscular torticollis is the postural deformity of the head and of the neck. The purpose of the present study is to evaluate the results of bipolar sternocleidomastoid (SCM) muscle tenotomy in children. METHODS: The present prospective study was conducted at the Department of Orthopedic Surgery from December 2010 to December 2014. A total of 34 children with congenital muscular torticollis and a mean age of 4.8 years (range: 1­14 years) were recruited from the Outpatient Department. They were treated with bipolar SCM muscle release under general anesthesia. The functional and cosmetic results were rated on a scoring system modified from Lim et al (2014). All of the children were followed-up for 2 years. RESULTS: At the final follow-up, the neck range of movement and head tilt improved and their appearance were cosmetically improved despite the long-standing nature of the deformity. The results were excellent in 30 patients (88.23%) and good in 4 patients (11.76%). No postoperative complications were found in any of the 34 patients. CONCLUSION: Bipolar tenotomy of the SCM muscle is a good method for correcting difficult cases of congenital muscular torticollis. It is a safe, effective and complicationfree method for these patients.

INTRODUCCIÓN: La tortícolis muscular congénita es la deformidad postural de la cabeza y del cuello. El propósito de este estudio es evaluar los resultados de la tenotomía del músculo esternocleidomastoideo bipolar en niños. MÉTODOS: Este estudio prospectivo, se realizó en el departamento de Cirugía Ortopédica a partir de diciembre de 2010 a diciembre de 2014. Treinta y cuatro niños con tortícolis muscular congénita con una edad media de 4,8 años (rango: 1 a 14 años) fueron reclutados del ambulatorio. Fueron tratados con liberación de músculo esternocleidomustoide bipolar bajo anestesia general. Los resultados funcionales y cosméticos se evaluaron en un sistema de puntuación modificado de Lim y col (2014). Todos los niños recibieron acompañamiento durante dos años. RESULTADOS: En el acompañamiento final, el rango del cuello del movimiento, la inclinación y su apariencia fueron cosméticamente mejorados a pesar de la permanente naturaleza de la deformidad. Los resultados fueron excelentes en treinta pacientes (88,23%) y bueno en cuatro pacientes (11,76%).. No se encontraron complicaciones en el post-operatorio de esos 34 pacientes. CONCLUSIÓN: La tenotomía bipolar de los esternocleidomastoideos es un buen método para corregir los casos de tortícolis muscular congénita.. Para los pacientes, es un método seguro, efectivo y sin complicaciones.

Effects of elastic therapeutic taping on motor function in children with motor impairments: a systematic review.

BACKGROUND: The elastic therapeutic taping has been considered a promising resource for disabled children. OBJECTIVE: To systematically review the evidence of the effects of elastic therapeutic taping on motor function in children with motor impairments. METHOD: Three independent evaluators conducted searches in electronic databases (MEDLINE/PubMed, Scopus, LILACS, BIREME/BVS, Science Direct, SciELO, and PEDro). Clinical studies design, published until 2016, involving elastic therapeutic taping and children aged 0-12 years with motor impairments were included. The variables considered were the methodological aspects (study design, participants, outcome measurements, and experimental conditions); results presented in the studies, and also the methodological quality of studies. RESULTS: Final selection was composed by 12 manuscripts (five randomized controlled trials), published in the last 10 years. Among them, cerebral palsy (CP) was the most recurrent disorder (n = 7), followed by congenital muscular torticollis (n = 2) and brachial plexus palsy (n = 2). Positive results were associated with taping application: improvement in the upper limb function, gross motor skills, postural control, muscular balance, and performance in the dynamics functional and daily activities. LIMITATIONS: Lower quality of the studies, clinical and population heterogeneity existed across studies. CONCLUSIONS: The elastic therapeutic taping has been shown to be a promising adjunct resource to the conventional rehabilitation in children with motor impairments. However, high methodological studies about its efficacy in this population are already scarce. Implications for Rehabilitation Elastic therapeutic taping has been shown to be a promising adjunct resource to the conventional rehabilitation in disabled children. Clinical trials have indicated improvement in the postural control and functional activities with both, upper and lower limbs, and increase in the functional independency resulting from the taping use. Randomized control trials and well-established protocols are needed to increase the confidence in applying elastic therapeutic taping to specific clinical conditions.

The physical, social and emotional aspects are the most affected in the quality of life of the patients with cervical dystonia.

OBJECTIVE: Describe the functional, clinical and quality of life (QoL) profiles in patients with cervical dystonia (CD) with residual effect or without effect of botulinum toxin (BTX), as well as verify the existence of correlation between the level of motor impairment, pain and QoL. METHOD: Seventy patients were assessed through the Craniocervical dystonia questionnaire-24 (CDQ-24) and the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). RESULTS: The greater the disability, pain and severity of dystonia, the worse the QoL (p<0.0001). Greater severity relates to greater disability (p<0.0001). Pain was present in 84% of the sample, being source of disability in 41%. The most frequent complaints were: difficulty in keeping up with professional and personal demands (74.3%), feeling uneasy in public (72.9%), hindered by pain (68.6%), depressed, annoyed or bitter (47.1%), lonely or isolated (32.9%). CONCLUSION: The physical, social and emotional aspects are the most affected in the QoL of these patients.

The physical, social and emotional aspects are the most affected in the quality of life of the patients with cervical dystonia / Os aspectos físicos, sociais e emocionais são os mais afetados na qualidade de vida dos pacientes com distonia cervical

Objective : Describe the functional, clinical and quality of life (QoL) profiles in patients with cervical dystonia (CD) with residual effect or without effect of botulinum toxin (BTX), as well as verify the existence of correlation between the level of motor impairment, pain and QoL. Method : Seventy patients were assessed through the Craniocervical dystonia questionnaire-24 (CDQ-24) and the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Results : The greater the disability, pain and severity of dystonia, the worse the QoL (p<0.0001). Greater severity relates to greater disability (p<0.0001). Pain was present in 84% of the sample, being source of disability in 41%. The most frequent complaints were: difficulty in keeping up with professional and personal demands (74.3%), feeling uneasy in public (72.9%), hindered by pain (68.6%), depressed, annoyed or bitter (47.1%), lonely or isolated (32.9%). Conclusion : The physical, social and emotional aspects are the most affected in the QoL of these patients. .

Objetivo : Descrever o perfil funcional, clínico e de qualidade de vida (QV) de pacientes com distonia cervical (DC) com efeito residual ou sem efeito da toxina botulínica (BTX), bem como verificar a existência de correlação entre o nível de comprometimento motor, dor e QV. Método : Setenta pacientes foram avaliados através do Craniocervical dystonia questionnaire-24 (CDQ 24) e Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Resultados : Quanto maior a incapacidade, dor e gravidade da distonia pior a QV (p<0,0001). A maior gravidade está relacionada à maior incapacidade (p<0,0001). A dor esteve presente em 84% da amostra sendo fonte de incapacidade em 41%. Dificuldade em manter-se com as demandas profissionais e pessoais (74,3%), sentir-se desconfortável em público (72,9%), prejudicado pela dor (68,6%), deprimido, irritado ou amargurado (47,1%), solitário ou isolado (32,9%) foram as queixas mais frequentes. Conclusão : Os domínios físico, social e emocional são os mais prejudicados na QV desses pacientes. .

Retrocollis, anterocollis or head tremor may predict the spreading of dystonic movements in primary cervical dystonia.

BACKGROUND AND PURPOSE: Few studies have attempted to develop clinical predictors for cervical dystonia (CD) aiming at progression of the dystonic movement. METHOD: We retrospectively evaluated 73 patients with primary CD who underwent treatment with Botulinum toxin type-A (BTX-A). The patients were assembled in two groups according to the spread of dystonia during follow-up: spreading and non-spreading CD. We performed a binary logistic regression model using spreading of cervical dystonia as dependent variable aiming to find covariates which increase the risk of spreading. RESULTS: Our logistic regression model found the following covariates and their respective risk ratios: time of disease >18.5 months=2.4, retrocollis=1.9, anterocollis=1.8, head tremor=1.6. CONCLUSION: Time of disease >18.5 months, retrocollis, anterocollis and head tremor may predict spreading of dystonic movement to other regions of the body in CD patients.

Retrocollis, anterocollis or head tremor may predict the spreading of dystonic movements in primary cervical dystonia / Retrocolis, anterocolis ou tremor cefálico podem predizer a progressão dos movimentos distônicos em pacientes com distonia cervical primária

BACKGROUND AND PURPOSE: Few studies have attempted to develop clinical predictors for cervical dystonia (CD) aiming at progression of the dystonic movement. METHOD: We retrospectively evaluated 73 patients with primary CD who underwent treatment with Botulinum toxin type-A (BTX-A). The patients were assembled in two groups according to the spread of dystonia during follow-up: spreading and non-spreading CD. We performed a binary logistic regression model using spreading of cervical dystonia as dependent variable aiming to find covariates which increase the risk of spreading. RESULTS: Our logistic regression model found the following covariates and their respective risk ratios: time of disease >18.5 months=2.4, retrocollis=1.9, anterocollis=1.8, head tremor=1.6. CONCLUSION: Time of disease >18.5 months, retrocollis, anterocollis and head tremor may predict spreading of dystonic movement to other regions of the body in CD patients.

INTRODUÇÃO: Poucos estudos avaliam preditores clínicos de progressão dos movimentos distônicos, para além da região cervical, em pacientes com distonia cervical (DC) primária. MÉTODO: Avaliamos, retrospectivamente, 73 pacientes com DC primária, que tinham sido submetidos ao tratamento com a toxina botulínica tipo A (BTX-A). Estes pacientes foram divididos em dois grupos de acordo com a progressão ou não da DC para outras áreas do corpo. Aplicamos um modelo de regressão logística binária usando a progressão da distonia como variável dependente com o objetivo de identificar co-variáveis que aumentassem o risco de progressão. RESULTADOS: O modelo de regressão logístico identificou as seguintes co-variáveis como preditoras de progressão e seus respectivos índices de risco: tempo de doença >18,5 meses=2,4, retrocolis=1,9, anterocolis=1,8, tremor cefálico=1,6. CONCLUSÃO: Tempo de doença >18,5 meses, retrocolis, anterocolis, e tremor cefálico podem predizer a progressão do movimento distônico para outras regiões do corpo em pacientes com DC primária.

Short-lived response of cervical dystonia to electroconvulsive therapy.

Cervical dystonia (CD) or spasmodic torticollis is the most frequent form of focal dystonia. Cervical dystonia is characterized by sustained neck spasms, abnormal head posture, head tremor, and pain. A 53-year-old male patient with the diagnosis of CD developed an episode of delusional depression and was treated with electroconvulsive therapy (ECT). An unexpected and dramatic improvement of CD was seen during the first 2 days after each ECT session. That therapeutic effect was not sustained and vanished soon afterward. The effectiveness of ECT for CD, although too brief to be recommended as a useful treatment, may shed light on the pathophysiology of this problematic movement disorder.

Relief of primary cervical dystonia symptoms by low frequency transcranial magnetic stimulation of the premotor cortex: case report.

OBJECTIVE: To evaluate the effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) on the symptoms of a patient with primary segmental dystonia (PSD). METHOD: 1200 TMS pulses at a frequency of 1Hz, over the premotor cortex, with an intensity of 90% of the motor threshold (MT), using an eight-shaped coil; a total of 5 sessions were carried out. RESULTS: A reduction of 50 percent in the neck subset of the Burke, Fahn and Marsden torsion dystonia scale (BFM) was observed in our patient. CONCLUSION: The reduction in the BFM scale supports the concept that rTMS of the premotor cortex may reduce specific motor symptoms in PSD.

Relief of primary cervical dystonia symptoms by low frequency transcranial magnetic stimulation of the premotor cortex: case report

OBJECTIVE: To evaluate the effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) on the symptoms of a patient with primary segmental dystonia (PSD). METHOD: 1200 TMS pulses at a frequency of 1Hz, over the premotor cortex, with an intensity of 90 percent of the motor threshold (MT), using an eight-shaped coil; a total of 5 sessions were carried out. RESULTS: A reduction of 50 percent in the neck subset of the Burke, Fahn and Marsden torsion dystonia scale (BFM) was observed in our patient. CONCLUSION: The reduction in the BFM scale supports the concept that rTMS of the premotor cortex may reduce specific motor symptoms in PSD.

OBJETIVO: Investigar o efeito da estimulação magnética transcraniana repetitiva (EMTr) de baixa freqüência nos sintomas de um paciente com distonia segmentar primária (DSP). MÉTODO: 1200 pulsos a uma freqüência de 1Hz, sobre o córtex pré-motor, a uma intensidade de 90 por cento do limiar motor (LM), usando uma bobina em forma de 8. Foram realizadas 5 sessões. RESULTADOS: Uma redução de 50 por cento no sub-item "pescoço" na escala de distonia de torção de Burke, Fahn e Marsden (BFM) foi observada no paciente em questão. CONCLUSÃO: A redução na escala BFM corrobora a idéia de que a EMTr sobre o córtex pré-motor pode reduzir sintomas motores específicos na DSP.

Resultados de la cirugía del tortícolis horizontal por nistagmus ocular congénito / Surgical results of horizontal ocular torticollis present in congenital nistagmus

Objetivo: Conocer los resultados de nuestra cirugía correctora del tortícolis (T) horizontal por nistagmus ocular congénito sin estrabismo. Material y Métodos: Estudio retrospectivo de 31 casos operados con diferentes procedimientos según las características del bloqueo y magnitud del T. Según esto último, los casos se clasificaron en 5 grupos. Resultados: La corrección del T fue exitosa (T residual del 12° o menos) en 80.7 por ciento del total de casos. En dos grupos obtuvimos curación del 100 por ciento de los casos, en otros 2,77 por ciento y 75 por ciento, respectivamente. En el 5° grupo la cirugía no fue uniforme y no es posible extraer normas de sus resultados. Como complicaciones tuvimos la aparición de un pequeño estrabismo en 3 casos y 4 pacientes debieron ser reintervenidos por tortícolis residual. Conclusiones: Las publicaciones con procedimientos comparables a los nuestros son escasas o con resultados vagos. Este estudio permite sacar guías quirúrgicas cuantitativas recomendables para 4 de los 5 grupos.

Purpose: To evaluate our surgical results in horizontal ocular torticollis present in congenital nystagmus without strabismus. Methods: A retrospective review was made in 31 consecutive patients, undergoing different surgical procedures considering the so called null zone and quantity of torticollis. Cases were classified in five groups. Results: In 80.7 percent of cases a successful result was obtained, defined as a residual torticollis not greater than 12°. Two groups obtained 100 percent correction. Two other groups obtained 77 and 75 percent correction respectively. The surgery indicated in group five was too heterogeneous and therefore non conclusive. After surgery a small strabismus presented in 3 cases. Four other patients were reoperated due to remaining torticollis. Conclusions: Papers with comparable procedures are few and don't show exact or detailed results. Our review allows us to obtain guide lines at least in 4 of the 5 groups.

Sternocleidomastoid pseudotumor and congenital muscular torticollis in infants: a prospective study of 510 cases.

OBJECTIVES: Congenital muscular torticollis is a common and controversial condition in infancy. We studied prospectively a group of infants with clearly defined sternomastoid tumor treated with a well-defined protocol. STUDY DESIGN: A total of 510 cases of sternomastoid tumor in infants over a 10-year period were studied prospectively with a mean follow-up of 3.5 years and a range from 1. 5 years to 13 years. The clinical presentations, associated abnormalities, treatments, and outcomes of the overall group and subgroups were evaluated to determine the most important prognostic factors. RESULTS: The mean age of presentation was day 24, with most (92.7%) presenting before the age of 3 months. There was a high correlation with breech presentation and assisted delivery. Clinical subgroups according to the deficit in passive rotation of the neck correlated with the incidence of hip dysplasia (up to 11.6%), mode of delivery, time of presentation, degree of craniofacial asymmetry, head tilt, and the size and extent of the pseudotumor (P <.05). With an early and prolonged manual stretching program, 90.7% had excellent and good overall results. The 6.7% of patients in the poor outcome group requiring surgical treatment all belonged to the more severe rotation limitation groups. CONCLUSIONS: Subgrouping patients with sternomastoid tumor according to the passive limitation of rotation of the neck has prognostic significance, with good overall results of conservative treatment with manual stretching.

Fibromatosis colli (Torticolis congénita), presentación de un caso / Fibromatosis colli. presentation of a case

La fibromatosis colli es una patología rara caracterizada por fibrosis del músculo esternocleidomastoideo, que se presenta clínicamente como una casa en el cuello. Aparece por lo general en el recién nacido, y debe reconocerse de manera temprana para proporcionar un tratamiento adecuado y oportuno. Se presenta el caso de un niño con fibromatosis colli bilateral, y se discuten aspectos de fisiopatogenia, diagnóstico y tratamiento de esta entidad