Postural responses to vibration of neck muscles in patients with idiopathic torticollis.

Abstract

Vibration of the dorsal muscles of the neck, simulating lengthening, in standing man causes a visible forwards tilt of the body shown on posturography as a tonic sagittal sway deviation. According to the theory that posture is organized with respect to a 'body schema' this deviation is a result of an interpretation of the concurrent neck afferent and vestibular signals. Considering the hypothesis that neck afferent signals may be misinterpreted in patients with spasmodic torticollis (ST) causing abnormal postural responses, we recorded body sway induced by unilateral dorsal neck muscle vibration in 22 idiopathic ST patients (19 treated with botulinum toxin) during upright stance with eyes closed. Comparison groups were 19 normal subjects and 11 patients with bilateral loss of vestibular function (labyrinthine defective, LD) in whom neck afference should be intact. Both treated and untreated ST and LD patients had absent or diminished sway deviations. When sway deviation did occur, it was sagitally oriented as with normal subjects and unrelated to ST head turns. In most ST and LD patients, neck vibration induced neck extension, an effect which is observed in normal subjects only if the torso is retrained. The results suggest that neck proprioceptive input retains local postural functions in ST, however, it is relatively ignored in the context of the whole body postural control and spatial orientation. The mild disorders of vestibular function reported in torticollis patients may be due to an inability to calibrate vestibular signals by reference to corroborative signals from neck proprioception.