Experimental spasmodic torticollis

Pathophysiology and pharmacotherapy of spasmodic torticollis: a review

The few existing neuropathological, neurochemical, and neuropharmacological studies have shed little light on the pathophysiology of spasmodic torticollis (ST). The relevance of experimental ST in animals and drug-induced ST in man to idiopathic ST is unclear. Most pharmacotherapeutic endeavors have focused on drugs affecting basal ganglia function. Unfortunately, problems of sample size, clinical heterogeneity of patient population, research design, objective evaluation of response, documentation of key data, and adequacy of duration of follow-up make interpretation of published results difficult. Because of the heterogeneity of ST, investigations aimed at establishing a neurotransmitter profile for each patient by observing the acute response to a test dose of drugs affecting cholinergic, dopaminergic, serotonergic, and gamma-aminobutyric acid systems may provide a more rational basis to the selection of treatment.

Torticollis caused by an infratentorial tumour: three cases

Three cases with torticollis caused by an infratentorial tumour are presented. A father and his son both had a Lindau tumour, and another patient had an ependymoma. It is stressed that torticollis may be the predominant or only sign of an infratentorial tumour, and that torticollis should always be suspected to have an organic origin.

Extrapyramidal dysfunction with cerebral arteriovenous malformations

Arteriovenous malformations have only rarely been implicated as a cause of basal ganglia dysfunction. In four instances where such a lesion was uncovered, abnormal involuntary movements were present. In two, tremor involving the contralateral limbs occurred, while in others the head and neck were involved in dystonic movements and posture. The clinical and angiographic characteristics of these four patients have been assessed and are presented in detail in this report. The possible mechanism by which arteriovenous malformations may disturb the internal circuitry of the basal ganglia and induce symptoms are discussed.

Spasmodic torticollis

Spasmodic torticollis is a distressing condition, characterised by involuntary and intermittent spasm of neck muscles, which in time become hypertrophied. It should be distinguished from a tic. Its incidence has been estimated at 1 in 1200 psychiatric referrals. Its relative rarity is a possible reason for the sparseness of the literature, which in turn helps to explain the confusion surrounding its aetiology. This is still unknown, but there is sufficient evidence to suggest that spasmodic torticollis is of interest as a model of “psychosomatic” illness, in that the convergence of a number of organic, personality, and situational factors may be necessary for its production.

On the problem of the pathology of spasmodic torticollis in man

Those regions which have been implicated by experimental and clinical neuropathological studies in the pathogenesis of spasmodic torticollis were examined in detail in the present patient and no histological abnormalities found. In the light of marked species differences in the effects of certain brain lesions on posture and the findings reported here, the pathogenesis of spasmodic torticollis in man may well be different from its pathogenesis in experimental animals.