Effect of Botulinum Toxin on Non-Motor Symptoms in Cervical Dystonia.

Patients with cervical dystonia (CD) may display non-motor symptoms, including psychiatric disturbances, pain, and sleep disorders. Intramuscular injection of botulinum toxin type A (BoNT-A) is the most efficacious treatment for motor symptoms in CD, but little is known about its effects on non-motor manifestations. The aim of the present study was to longitudinally assess BoNT-A's effects on CD non-motor symptoms and to investigate the relationship between BoNT-A-induced motor and non-motor changes. Forty-five patients with CD participated in the study. Patients underwent a clinical assessment that included the administration of standardized clinical scales assessing dystonic symptoms, psychiatric disturbances, pain, sleep disturbances, and disability. Clinical assessment was performed before and one and three months after BoNT-A injection. BoNT-A induced a significant improvement in dystonic symptoms, as well as in psychiatric disturbances, pain, and disability. Conversely, sleep disorders were unaffected by BoNT-A treatment. Motor and non-motor BoNT-A-induced changes showed a similar time course, but motor improvement did not correlate with non-motor changes after BoNT-A. Non-motor symptom changes after BoNT-A treatment are a complex phenomenon and are at least partially independent from motor symptom improvement.

Estimulación cerebral profunda bilateral para distonía cervical refractaria en el Hospital Universitario de San Ignacio de Bogotá, Colombia / Bilateral Deep Brain Stimulation for Refractory Cervical Dystonia. Hospital Universitario de San Ignacio in Bogotá, Colombia: A Case Report

La estimulación cerebral profunda (ECP) es una alternativa de manejo para los pacientescon distonía cervical, un síndrome de etiología múltiple, de presentación variada eincapacitante y refractario al manejo médico, que incluye la toxina botulínica. El artículopresenta el caso de una mujer de 56 años de edad con distonía cervical manifiesta conretrócolis e hiperextensión de columna dorsal, de cuatro años de evolución, consideradarefractaria al tratamiento y con indicación de ECP...

Deep brain stimulation (DBS) is a management alternative for patients with cervicaldystonia, syndrome of multiple etiology, presentation varied, disabling and refractoryto medical management, including botulinum toxin. A case of a 56 year old woman withcervical dystonia manifested by retrocollis and hyperextension dorsal spine of 4 yearsof evolution, considered resistant to treatment that is an indication of DBS is presented...

Superior colliculus mediates cervical dystonia evoked by inhibition of the substantia nigra pars reticulata.

Cervical dystonia (CD; spasmodic torticollis) can be evoked by inhibition of substantia nigra pars reticulata (SNpr) in the nonhuman primate (Burbaud et al., 1998; Dybdal et al., 2012). Suppression of GABAergic neurons that project from SNpr results in the disinhibition of the targets to which these neurons project. It therefore should be possible to prevent CD by inhibition of the appropriate nigral target region(s). Here we tested the hypothesis that the deep and intermediate layers of the superior colliculus (DLSC), a key target of nigral projections, are required for the emergence of CD. To test this hypothesis, we pretreated the DLSC of four macaques with the GABA(A) agonist muscimol to determine whether this treatment would prevent CD evoked by muscimol infusions in SNpr. Our data supported this hypothesis: inhibition of DLSC attenuated CD evoked by muscimol in SNpr in all four animals. In two of the four subjects, quadrupedal rotations were evoked by muscimol application into SNpr sites that were distinct from those that induced dystonia. We found that inhibition of DLSC did not significantly alter quadrupedal rotations, suggesting that this response is dissociable from the SNpr-evoked CD. Our results are the first to demonstrate a role of DLSC in mediating the expression of CD. Furthermore, these data reveal a functional relationship between SNpr and DLSC in regulating posture and movement in the nonhuman primate, raising the possibility that the nigrotectal pathway has potential as a target for therapeutic interventions for CD.

Supine infant positioning--yes, but there's more to it.

The Back-to-Sleep campaign has helped reduce the incidence of SIDS, but a neglect of prone positioning during wakefulness has increased the risk of 3 complications.

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.

The sternocleidomastoid tumor of infancy.

The sternocleidomastoid tumor of infancy is an uncommon clinical entity which has received little attention in the otolaryngological literature. The diagnosis must be considered in any infant presenting with a lateral neck mass. Although its natural history favors spontaneous regression, the mass may initially grow in size. The purpose of treatment is the prevention of torticollis and craniofacial asymmetry. The initial treatment is non-surgical, passive and active exercises. Only when this treatment fails should surgery be performed. The disappearance of the lesion is not always a predictable sign. A small number of children will develop delayed torticollis or craniofacial asymmetry. It is important that parents be informed of this possibility and of the necessity for long term follow-up.

Large bilateral medial rectus recession in early esotropia with bilateral limitation of abduction.

Large bilateral medial rectus recession was performed in a group of 85 patients presenting early large angle esotropia with bilateral limitation of abduction. The results obtained after three postoperative years demonstrated that the proposed method not only corrects the angle of deviation but significantly improves abduction and consequently torticollis. In spite of the large recession performed, both adduction and convergence were not significantly affected.