torticollis_children

The following article was taken from ST/Dystonia Inc. newsmagazine. I wish to thank Dr Auberle for this informative article. Also Dystonia Inc. for printing it. See my Links section to get to their WEBsite. As I obtain more information about torticollis is infants and children, I will add to my site. KS

Childhood Torticollis

James Auberle, M.D.

Children and Torticollis
Several times during the year, I am contacted by one of my health professional colleagues concerning one of their FLK's (Funny Looking Kids). Although this particular terminology is not politically correct, it relates a common dilemma. It doesn't matter if it is a doctor with years of experience or a student nurse. They will often have difficulty describing the particular problem i.e."� his/her neck bends then twists then it does this weird thing�" There are several variations on this main theme. All they truly know is that the child doesn't look like they expect. One very important factor in determining how to approach a child with some form of torticollis is to know the age of onset. Newborns are treated a little differently than older children. The length of time the child has had the torticollis is also a consideration. For example, if a newborn is evaluated, it is important to know the history of the family, the conditions of the pregnancy, and how the baby was delivered. Other information such as - were forceps or suction used in the delivery; how did the child behave immediately after birth? Another important point here is that these forms of torticollis are usually not associated with any of the forms of dystonia. Yes, I'm sorry to say that there are forms of torticollis that do not have any abnormalities of tone. How can we tell? When an EMG needle is placed into the muscle of non-dystonic type of torticollis, there will be little to no electrical activity of the muscle. Consequently, these types of patients may not necessarily respond to treatment with medications such as Botox injections or the more traditional oral medication either. Below is a table of diseases or conditions that can cause torticollis. These conditions do not have the movement disorder, dystonia, the abnormally increased amounts of tone (muscle activity) responsible for their head/neck positioning. Torticollis Causes Other than Dystonia I. Congenital A. Malformations 1. Malformations of the cervical spine 2. Absence or hypertrophy of cervical muscles 3. Malformations of the CNS (Arnold-Chiari Malformations) B. Deformations (congenital postural torticollis) 1. Uterine (womb) abnormalities 2. Oligohydramnios (too little amniotic fluid) 3. Fetal crowding a. large baby b. multiple babies C. Congenital Muscular Torticollis II. Acquired A. Cervical musculo-skeletal abnormalities 1. Atlanto-axial rotatory dislocation 2. Atlanto-axial anterior subluxation 3. C2-C3 rotary dislocation 4. Other bony abnormalities 5. Infection 6. Traumatic soft tissue injury to the neck B. Neurological abnormalities 1. Cervical spinal cord lesions a. syringomyelia (cavity within the spinal cord) b. spinal cord tumors 2. Intracranial lesions a. posterior fossa tumors b. syringobulbia (cavity within the brainstem) c. colloid cyst of the IIIrd ventricle 3. Peripheral nerve lesions a. tumor of the XIth cranial (spinal accessory) nerve C. Miscellaneous 1. Ocular torticollis 2. Sandifer's syndrome 3. benign paroxysmal torticollis 4. vestibular torticollis 5. neuromuscular disorders 6. psychological When dealing with these non-dystonic forms of torticollis it is very important to identify the more serious conditions from those not life threatening. If one of the above conditions is caused by trauma, such as a serious neck injury, immobilization and possibly immediate surgery are recommended treatments. These would include the alanto-axial dislocations or subluxations. Other serious causes include those related to tumors of the neck or brainstem. For these conditions, it is best to make sure that a neuro-imaging procedure has been performed. This usually means a MRI (Magnetic Resonance Imaging) of the cervical spine or brain. Newborns also deserve some special considerations. The first step is to make certain there is no evidence of tumor or one of the other serious diseases. Once there is nothing to suggest any permanent dysfunction to the neck involving the spine or musculature, then all that may be needed is a little physical therapy and passive stretching to see these children develop into normal childhood. If the baby does not appear to be having difficulty with its neck, then so should you. Besides, have you looked in the mirror at the 2 am feeding and had a straight neck? I recommend that for children with the non-dystonic forms of torticollis, that you seek out the help of a pediatric neurologist. If you were lucky to have a pediatric neurologist who specializes in movement disorders nearby then I would seek out this particular person for advice. Unfortunately, as many of our patrons have told us, finding a physician who understands dystonia is hard enough, finding a pediatric neurologist who specializes in movement disorders is like finding a Botox needle in a haystack! James Auberle, M.D. Medical Director, ST/Dystonia Toledo Clinic 4235 Secor Rd. Toledo, OH 43623 (419) 479-5534

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