Abnormal Head Posture Research Articles

Tortícolis ocular en el niño con síndrome de Down

Purpose To ascertain the prevalence of torticollis in patients with Down syndrome (DS). Methods 760 patients with confirmed DS underwent complete ophthalmologic examination, which included visual acuity, refraction, ocular motility and head position. Results Torticollis was present in 75 patients (9.86%). 80% of them were found to have an up or toward a shoulder head tilt. Out of 28 patients with torticollis (37.33%) had a nystagmus, and 11 (14.66%) had a fourth nerve palsy. In 23 patients (30.66%) no ocular etiology for the abnormal head position could be identified. Conclusions Abnormal head positions are more common in patients with DS than in general population. Superior oblique muscle paresis and nystagmus have been the most common ocular etiologies in our group of patients. Another patients seem to have no ocular reasons for their head tilt. Torticollis doesn’t form a part of DS phenotype so, we have to look for its aetiology.

Ocular torticolis in Down syndrome

ObjectiveTo determine the prevalence of torticollis in Down syndrome (DS) patients. Methods760 patients with DS underwent a complete eye examination that included visual acuity, ocular motility, refraction and head posture. ResultsSome form of torticollis was present in 75 patients (9.86%). In 80% it was accompanied by chin elevation or head tilt over one or the other shoulder. In 28 patients (37.33%) torticollis was concomitant with nystagmus and 11 cases (14.66%) presented fourth nerve palsy. In 23 patients (30.66%) no eye condition could be found to explain the abnormal head posture. ConclusionsTorticollis is more common in DS patients than in the general population. Fourth nerve palsy and nystagmus were the most common ocular causes in our group of patients. Some patients appeared to have no ocular causes for their head tilt. Torticollis is not part of the DS phenotype, so its aetiology must be sought.

Superior Oblique Tendon Expanders with Inferior Recti Recessions for Chin-Up Null Point Nystagmus

Introduction: Patients with nystagmus may adopt a chin-up head position if the null point of their nystagmus is positioned in downgaze. Large bilateral superior recti resections have been combined with inferior recti recessions to elevate the null point, thereby reducing the abnormal head position. This approach may require limitation of downgaze to be effective. Methods: In this paper, we retrospectively review three children who underwent bilateral superior oblique tendon expanders combined with inferior recti recessions to treat their chin-up head positions. All had variable amounts of chin-up, but all measured at least 20 degrees or more. All had intermittent chin-up head positions when visually concentrating, of sufficient frequency to cause functional complaints. One patient had previous strabismus surgery on all four horizontal recti. Results: Two patients had complete resolution of their abnormal vertical head position. The third showed improvement in both frequency and amplitude of the chin-up position. All patients retained full versions in downgaze. No patient complained of torsional symptoms. Conclusion: Superior oblique tendon expanders combined with inferior recti resections may reduce chin-up abnormal head positions in null point nystagmus. This method is particularly useful when previous strabismus surgery limits the number of recti muscles available for surgery. Advantages of using superior oblique tendons expanders rather than vertical recti recess/resect procedures also include sparing recti muscles in the case of future surgery, and not requiring downgaze restriction for success.

Body sway increases immediately after strabismus surgery.

The purposes of this study were to examine whether body sway is altered immediately after strabismus surgery in children and to find preoperative clinical factors associated with body sway. In a prospective study, body sway was measured on 1-3 days before surgery and on the third day after surgery; for the measurements, computerized static stabilometry was carried out on 28 consecutive patients with strabismus (age range: 3 to 12 years old; mean: 7.4) who underwent strabismus surgery under general anesthesia. The linear length of the sway path (cm), the linear length of the sway path in a particular unit of time (cm/second), and the area of the sway path (cm2), indicative of the extent of body sway, all increased significantly among a total of 28 patients in both conditions of the patient's eyes open and closed, as well as among those in a subgroup of 16 patients with exotropia, after they had undergone strabismus surgery (p < 0.05, Wilcoxon signed ranks test). The center of pressure along the Y axis of orientation from the toe to the heel was found to deviate significantly toward the heel postoperatively, as compared with the preoperative center in the subgroup of 16 patients with exotropia (p < 0.05). Before surgery, 15 patients with no stereoacuity exhibited a greater amount of body sway when their eyes were open than did 13 patients with measurable stereoacuity (p < 0.05, Mann-Whitney U-test). In the subgroup of 16 patients with exotropia when their eyes open, 3 patients with abnormal head posture exhibited more extensive body sway than did 13 patients without abnormal head posture (p < 0.05). Body sway was found to significantly increase immediately after strabismus surgery in children with strabismus. Stereoacuity and abnormal head posture are 2 clinical factors associated with preoperative postural instability.

Anterior and Nasal Transposition of the Inferior Oblique in Patients with Isolated Superior Oblique Tendon Absence

Introduction: Patients with missing superior oblique (SO) tendons present with overelevation/underdepression in adduction and excycloduction. In bilateral cases there may be a marked V- or Y-pattern, while unilateral cases often exhibit abnormal head postures. These patients may have craniofacial dysostosis (Apert or Crouzon syndrome). We previously described anterior and nasal transposition (ANT) of the inferior oblique (IO) muscles as a powerful IO weakening procedure that alleviates the cycloduction (J AAPOS 2003;7:167-73). Here we report findings with ANT in patients with missing SO tendons. Methods: Seven children with unilateral (N= 2) or bilateral (N= 5) absent SO tendons underwent ANT of the IO muscles in the affected eyes and were seen 1 to 147 weeks postoperatively. Results: Postoperatively, all patients were much improved. Both unilateral cases appeared orthophoric in primary position with no abnormal head posture. In the bilateral cases, vertical deviation in adduction and exodeviation in upgaze had largely cleared, although some vertical deviation in sidegaze (two patients) and 10 PD intermittent exotropia in primary position (one patient) remained. Most notably, one patient showed 30 PD constant esotropia in downgaze. Although it was not feasible to assess cyclodeviation using the double Maddox rod in these children, significant improvements in fundus ex-torsion were seen. Conclusions: The ANT procedure corrects, at least partially, the vertical deviation in adduction, exodeviation in upgaze, and ex-torsion, but esodeviation may persist in downgaze. This procedure could also be beneficial in cases of severe SO palsy when more conventional surgery fails.

Baclofen for Patients with Congenital Periodic Alternating Nystagmus

Purpose: To describe the clinical effect of baclofen on a group of patients with congenital periodic alternating nystagmus. Methods: A retrospective review of case notes was carried out of all patients with congenital periodic alternating nystagmus (PAN) treated with baclofen between 1999 and 2004. Eight patients were identified, 6 males and 2 females with a mean age of 21 years (range 9 to 34 years). Clinical data were recorded for all patients pre- and post-treatment with the GABA agonist baclofen. Adverse effects of the treatment were recorded and a questionnaire was constructed to evaluate patient satisfaction with the treatment. Results: All 8 patients had an abnormal head posture (AHP) before treatment which improved following treatment in 4 patients, one of whom had recurrence following treatment withdrawal. Binocular Snellen visual acuity (VA) improved by one line in 4 cases, while none of the other 4 patients suffered any loss of vision from the treatment. Three of the eight patients have continued on treatment long-term, in one case for 6 years. In the other five, treatment was withdrawn due to side effects in 4 cases, and in the fifth due to a lack of effect. The most commonly reported side effect was drowsiness, which occurred in 3 patients. Using a patient-centered survey, complete responses were obtained from 6 of the 8 patients treated. Five patients were either pleased or very pleased that they had tried the treatment. The reasons given were: improved vision or head posture, an appreciation of slowing of ocular movements, improved cosmesis and improved confidence. Conclusions: Baclofen may be effective in a select group of patients with congenital PAN and a trial of treatment may be worthwhile, prior to considering surgical intervention in this condition.

Posição viciosa de cabeça por astigmatismo mal corrigido: relato de caso

Abnormal head position is a compensatory condition which improves patients' vision. It can be caused by ophthalmological problems such as oculomotor imbalances (strabismus, nystagmus) and high astigmatism. However, it results in esthetic impairment, orthopedic trouble and facial asymmetries. We describe a case of a girl, JL, 8 years, with abnormal head position tilted to the left since the last glasses were prescribed. The correction used by the patient was: right eye = +2.00 sph diopter -5.5 cyl 180 degrees and left eye = +2.25 sph diopter -5.75 cyl 180 degrees. In tilted position, the correct visual acuity was: right eye 6/12 and left eye 6/9. No deviations were noted by the cover test and the remaining ophthalmological examination was completely normal. Retinoscopy under cycloplegia and subjective test showed right eye = +3.50 sph diopter -6.00 cyl 10 degrees; and left eye = +3.50 sph diopter -6.00 cyl 170 degrees, with visual acuity 6/6 in both eyes. With adequate prescription, the head position was normalized. Wrong cylindrical positions for correction of high astigmatism may cause abnormal head position. Retinoscopy under cycloplegia and subjective test are essential for precise diagnoses and prescriptions.

The Effect of Bilateral Horizontal Rectus Recession on Visual Acuity, Ocular Deviation or Head Posture in Patients with Nystagmus

This work was undertaken to evaluate the effect of bilateral horizontal rectus recession on visual acuity, ocular deviation and head posture in patients with nystagmus. Twenty patients underwent recession of 4 horizontal rectus muscles to dampen the nystagmus. At least 2 muscles were recessed posterior to the equator. Monocular and binocular visual acuity improved from 1 to 3 Snellen lines after the procedure in 13 patients (76.5%). Visual changes in log MAR notations were statistically significant with Wilcoxon analysis in each and both eyes. Preoperative binocular visual acuity was 0.73 +/- 0.26 log MAR that reached to 0.62 +/- 0.32 log MAR after surgery (P = 0.02). The greatest improvement was observed in patients with congenital motor nystagmus. Ten patients had horizontal strabismus in addition to nystagmus before the surgery. One-millimeter additional recession of both medial rectus muscles caused an average reduction of 6 PD in esotropia. Corresponding figures for similar additional recessions of the lateral rectus muscles was 11 PD for correction of exotropia. Abnormal head posture decreased in all the cases and improved completely in most of them. Large horizontal rectus recession can improve visual acuity and decrease nystagmus in sensory and motor types. By revision in surgical planning, strabismus and abnormal head posture can also be corrected.

Co-occurrence of West Nile Fever and circovirus infection in a goose flock in Hungary

The authors investigated an outbreak of West Nile Fever characterized by severe neurological symptoms and death in a flock of 3600 6-week-old geese. Ataxia, intermittent torticollis and opisthotonus, incoordination, rhythmic side-to-side movement of the head, wriggling of the neck and abnormal head position were features of the disease. Death occurred within 4 to 5 days after the clinical signs appeared. The average daily mortality was 5 to 15, reaching 14% (in total) over a period of 6 weeks. There were no consistent gross pathological lesions, but in a few cases yellowish-grey foci of 3 to 6 mm in diameter were observed on the surface or transection of the brain. Histopathology revealed perivascular lymphohistiocytic infiltration and glia cell proliferation in the brainstem, cerebellum, cortex and spinal cord as well as degeneration of neural fibres in the spinal cord. In addition to the lesions caused by the West Nile Virus in the brain, characteristics of circovirus infection such as lymphocyte depletion, vacuolization and basophilic intra-cytoplasmic inclusion bodies containing circovirus-like particles were seen by light and electron microscopy in the cloacal bursa. West Nile Virus infection was confirmed by reverse transcriptase-polymerase chain reaction amplification of virus-specific nucleic acid from tissue samples of the brain. Based on the nucleotide sequence analysis of the polymerase chain reaction products, 99% identity was found on the tested NS5 region with the IS-98 ST1 strain isolated from a stork in Israel in 1998, and with West Nile Virus stains emerging in the USA in 1999. Using an indirect fluorescent antibody test, high antibody titres against the virus were detected in the serum samples submitted from the affected flock. In selected sera this was confirmed by neutralization antibody test as well.

Effect of Full Tendon Transposition Augmented With Posterior Intermuscular Suture for Paralytic Strabismus

To evaluate the results of the full rectus muscle transposition augmented with a posterior intermuscular suture for paralytic strabismus. Single-center, retrospective, interventional case series. This study retrospectively reviewed the medical records from November 1994 to September 2004 of 16 patients who underwent the full tendon transposition that was augmented with posterior intermuscular suture for paralytic strabismus. This series evaluated the results of a single transposition surgery; five patients had previous nontransposition strabismus surgery. The following data were analyzed before and after the operation: (1) the angle of deviation in the primary position, (2) the presence of diplopia in the primary position, (3) the binocular single visual fields, (4) the presence of an abnormal head posture, (5) the motility of the affected eye, and (6) the procedure that was performed. The preoperative angle of deviation in the primary position was 59 +/- 22 prism diopter (prism diopter; range, 30 to 115 prism diopter) compared with 17 +/- 12 prism diopter (range, -10 to 40 prism diopter) after the operation. The preoperative binocular single visual fields improved from 0 degrees to 60 +/- 25 degrees (range, 0 to 90 degrees) after the operation. Diplopia in the primary position was resolved in 11 patients (69%) after the operation. There were no complications such as scleral perforation, unwanted vertical deviations, or anterior segment ischemia in any of the cases during the procedure and postoperative follow-up. Full tendon transposition that is augmented with a posterior intermuscular suture is an effective procedure that results in improved ocular alignment in patients with paralytic strabismus and has a favorable complication profile.

Operationsergebnisse bei kongenitalem Brown-Syndrom

There are various surgical procedures for the treatment of congenital ("true") Brown's syndrome. We have evaluated the effects of a superior oblique tendon recession. In a retrospective study, we evaluated the files of 22 patients who received surgery for congenital Brown's syndrome in our department. A recession of the superior oblique tendon was performed, when there was a hypotropia in primary position with an abnormal head posture and a significant elevation deficit in adduction, and when these findings did not improve spontaneously. The squint angles (alternate prism and cover test), the monocular motility and the abnormal head posture at distance fixation were assessed. The measurements were performed 1 day before and 3 months after surgery. Thirteen patients were examined 2 - 10 years after surgery. At the time of surgery, the patients were 4 - 17 years old (median 7 years), 13 were male, in 15 patients, the right eye was concerned. Eight patients had an additional esotropia, one patient was exotropic. The vertical deviation in straight gaze was 0 - 12 deg (median 7 deg). The elevation of the eye was restricted to - 10 deg (below horizontal) to 15 deg (median 0 deg) in adduction and to 10 - 35 deg (median 25 deg) in abduction. Sixteen patients had an abnormal head posture. The superior oblique tendon was recessed by 10 mm, in some patients with an additional loop (6x0 polyester). Nine patients received simultaneous surgery for their eso/exotropia. At the end of the operation, the elevation of the eye in adduction (forced duction test) was free. Three months postoperatively, the vertical deviation was 0 - 6 deg (median 1 deg). Twelve patients did not show any abnormal head posture. Inspite of free passive motility, the monocular elevation in adduction was only slightly improved to - 5 to 15 deg (median 5 deg). At the late control, the hypotropia (0 - 4 deg, median 0 deg) and the elevation in adduction (5 - 35 deg, median 15 deg) were significantly improved. The recession of the superior oblique tendon is an effective and safe surgical procedure for congenital Brown's syndrome. The efficiency of the procedure is individually variable. Presumably, this variability was caused by the heterogenous etiology of Brown's syndrome rather than by surgical technique. The hypotropia and the abnormal head posture were reduced immediately after surgery, while the delayed improvement of active elevation in adduction often remained incomplete. Postoperative forced upgaze training may be beneficial.

Familial Aplasia of the Inferior Rectus Muscles

We describe inferior rectus aplasia in three members of a family. No family member showed signs of craniofacial dysostosis syndromes or neurofibromatosis. A woman with abnormal head posture, right exotropia, and right hypotropia presented to our clinic. She mentioned that her two children had similar problems. A provisional diagnosis of ocular fibrosis or atypical Duane syndrome was made and she underwent surgery. During surgery, the inferior rectus muscle could not be identified in either eye. Subsequently, her children were examined and orbital magnetic resonance imaging (MRI) was performed for all family members. MRI confirmed bilateral absence of the inferior rectus muscles in the mother and unilateral absence with atrophic and fibrotic contralateral inferior rectus muscles in the children. This is the first report in the literature of a family with aplastic inferior rectus muscles with no signs of craniosynostosis or neurofibromatosis.

Animal Models of Focal Dystonia

Animal models indicate that the abnormal movements of focal dystonia result from disordered sensorimotor integration. Sensorimotor integration involves a comparison of sensory information resulting from a movement with the sensory information expected from the movement. Unanticipated sensory signals identified by sensorimotor processing serve as signals to modify the ongoing movement or the planning for subsequent movements. Normally, this process is an effective mechanism to modify neural commands for ongoing movement or for movement planning. Animal models of the focal dystonias spasmodic torticollis, writer's cramp, and benign essential blepharospasm reveal different dysfunctions of sensorimotor integration through which dystonia can arise. Animal models of spasmodic torticollis demonstrate that modifications in a variety of regions are capable of creating abnormal head postures. These data indicate that disruption of neural signals in one structure may mutate the activity pattern of other elements of the neural circuits for movement. The animal model of writer's cramp demonstrates the importance of abnormal sensory processing in generating dystonic movements. Animal models of blepharospasm illustrate how disrupting motor adaptation can produce dystonia. Together, these models show mechanisms by which disruptions in sensorimotor integration can create dystonic movements.

A Multi-Disciplinary Study of the Ocular, Orthopedic, and Neurologic Causes of Abnormal Head Postures in Children

To determine the relative frequency that abnormal head postures in children are caused by orthopedic, ophthalmologic, or neurologic disorders, respectively. A prospective, consecutive case series. Children found to have an abnormal head posture on routine pediatric examination underwent an evaluation by a pediatric ophthalmologist, pediatric orthopedist, and pediatric neurologist. The study was conducted in northwestern Italy. In the 63 children evaluated, the cause of the abnormal head posture was orthopedic in 35, ocular in 25, and neurologic in 5. In 8 patients, no specific cause could be found. The most common orthopedic cause was congenital muscular torticollis, which accounted for 31 patients. The most common ocular cause was superior oblique muscle palsy, which accounted for 12 patients. In 2 patients neck muscle contracture suggested an orthopedic cause, however, the tight neck muscles were secondary to a head tilt caused by superior oblique muscle palsy. When the cause of an abnormal head posture is not obvious, a multi-disciplinary approach including ophthalmologic, neurologic, and orthopedic specialists may be helpful.

Changes in Fetal Position During Labor and Their Association With Epidural Analgesia

To evaluate whether epidural analgesia is associated with a higher rate of abnormal fetal head position at delivery. We conducted a prospective cohort study of 1,562 women to evaluate changes in fetal position during labor by using serial ultrasound examinations. Ultrasound examinations were performed at enrollment, epidural administration, 4 hours after the initial ultrasonography if epidural had not been administered, and late in labor (> 8 cm). Information about fetal head position at delivery was obtained from the provider. Regardless of fetal head position at enrollment (occiput transverse, occiput posterior, or occiput anterior), most fetuses were occiput anterior at delivery (enrollment position: occiput transverse 78%, occiput posterior 80%, occiput anterior 83%, P = .1). Final fetal position was established close to delivery. Of fetuses that were occiput posterior late in labor, only 20.7% were occiput posterior at delivery. Changes in fetal head position were common, and 36% of women had an occiput posterior fetus on at least one ultrasound examination. Women receiving epidural did not have more occiput posterior fetuses at the enrollment (23.4% epidural versus 26.0 no epidural, P = .9) or the epidural/4-hour ultrasound examination (24.9% epidural, 28.3% no epidural), but did have more occiput posterior fetuses at delivery (12.9% epidural versus 3.3% no epidural, P = .002); the association remained in a multivariate model (adjusted odds ratio 4.0, 95% confidence interval 1.4-11.1). Fetal position changes are common during labor, with the final fetal position established close to delivery. Our demonstration of a strong association of epidural with fetal occiput posterior position at delivery represents a mechanism that may contribute to the lower rate of spontaneous vaginal delivery consistently observed with epidural.

Das Kopfneigephänomen bei einseitigen und beidseitig symmetrischen Trochlearisparesen

The head-tilt phenomenon (difference between the vertical deviations with an ipsilateral and contralateral head-tilt by 45 deg. each) occurring in patients with a superior oblique palsy has traditionally been explained by the lacking contraction of the superior oblique muscle within the synkinetic movement of ocular counterrolling. However, using a computer model, Robinson showed that the superior oblique palsy itself causes only a relatively small head-tilt phenomenon. Adaptive mechanisms amplifying the otolith reflex were suggested to explain the increase of the head-tilt phenomenon in the course of time. In order to reduce the abnormal head posture required for binocular vision, the otolith reflex would be amplified, accepting the greater vertical deviation when the head is tilted to the paretic side . If the head-tilt phenomenon were solely caused by the lacking contraction of the superior oblique muscle, it should be greater in bilateral than in unilateral superior oblique palsies. If an adaptive mechanism were acting to reduce the abnormal head posture, the head-tilt phenomenon should not be greater, and could even be smaller in bilateral than in unilateral superior oblique palsy, because in bilateral (symmetric) trochlear nerve palsies the vertical deviation at straight gaze is already small or absent without adaptation. We have carried out a retrospective comparison of 10 patients with bilateral symmetric superior oblique palsies and 10 patients with unilateral superior oblique palsy. In all cases, the palsy was acquired and had been present for at least 1 year. The patients with bilateral superior oblique palsy had a head-tilt phenomenon ranging from 0 to 7 degrees (median, 2 deg.). The patients with unilateral superior oblique palsy had a head-tilt phenomenon between 2 and 13 degrees (median, 8 deg.). The difference was significant (p = 0.0117). The head-tilt phenomenon is smaller in long-standing bilateral symmetric superior oblique palsies than in long-standing unilateral superior oblique palsy. This finding supports the hypothesis that in unilateral superior oblique palsy, an adaptive mechanism augments the head-tilt phenomenon by an amplification of the otolith reflex. However, we presume that the amplification of the otolith reflex is only a side effect of the adaptive change of the vertical fusional vergence tonus and thus the price of the improved vertical fusion, rather than a compensatory mechanism.

Role of Visual Dysfunction in Postural Control in Children With Cerebral Palsy

Introduction: Deficient postural control is one of the key problems in cerebral palsy (CP). Little, however, is known about the specific nature of postural problems of children with CP, nor of the relation between abnormal posture and dysfunction of the visual system. Aim of the study: To provide additional information on the association of abnormalities in postural control and visual dysfunction of the anterior or posterior part of the visual system. Methods: Data resulting from ophthalmologic, orthoptic, neurological, neuro-radiological, and ethological investigations of more than 313 neurologically impaired children were retrospectively analyzed. Results: Abnormal postural control related to ocular and ocular motor disorders consisted of anomalous head control and subsequent abnormal head posture and torticollis. The abnormal postural control related to retrochiasmatical damage of the visual system consisted of a torticollis combined with adjustment of the upper part of the body, as if at the same time adapting to a combination of defects and optimizing residual visual functions. Conclusion: Visual dysfunctions play a distinct role in the postural control of children with CP.

Vertical rectus muscle surgery for nystagmus patients with vertical abnormal head posture

Purpose To characterize the results of vertical rectus muscle recession, or recession and resection surgery for vertical abnormal head posture (VAHP) due to null-point nystagmus. Method This is a retrospective, noncomparative, consecutive case series of patients who underwent vertical rectus muscle recession alone, recession then resection, or combined recession/resection surgery for VAHP due to null-point nystagmus. The primary outcome measure was the amount of residual VAHP. Results Twenty patients with VAHP due to null-point nystagmus were studied. The mean follow-up interval after surgery was 49 months (median: 44 months; range 9 to 124 months). Preoperative VAHP ranged from 10° to 45°, and the total amount of bilateral vertical rectus muscle recession, or recession and resection surgery, ranged from 8.5 to 20.0 mm per eye. After recession alone, 5/11 had residual VAHP ≤ 5°. The remaining six underwent subsequent resection or plication for residual VAHP > 10° that resulted in residual VAHP ≤ 5° in each case. After combined recession/resection, 6/9 had residual VAHP ≤ 5° and the remaining three had VAHP < 10°. Conclusion Large amounts of vertical rectus muscle surgery are indicated to successfully correct the VAHP associated with nystagmus with a vertical null point. Combined recession/resection of the appropriate vertical rectus muscles, instead of recession alone, appears to be a more effective procedure.

Inferior oblique muscle myectomy in the management of congenital superior oblique muscle palsy

目的 探讨下斜肌部分切除术治疗先天性上斜肌麻痹的效果.方法观察17例接受下斜肌部分切除术治疗的先天性上斜肌麻痹术前术后9方位眼位,歪头试验及代偿头位的变化.结果垂直眼位变化小于15△的先天性上斜肌麻痹患者术后眼位及代偿头位均恢复,大于15△的仍残留部分眼位异常及代偿头位.结论下斜肌部分切除术对垂直眼位变化小于15△的先天性上斜肌麻痹有效。

Alexithymia is no risk factor for exacerbation in spasmodic torticollis patients

Objective: To assess whether alexithymia is a risk factor for exacerbation in spasmodic torticollis (ST). Methods: ST patients (2×10) with high vs. low alexithymia scores (mean score on the 20-item Toronto Alexithymia Scale [TAS-20]=69.2 vs. 28.7) were compared on physiological, motor and subjective responses to a cognitive and an emotional laboratory stressor. Changes in sustained abnormal head/shoulder positions and maximum range of motion (ROM) of the cervical spine were kinematically quantified. Skin conductance level (SCL), nonspecific skin conductance fluctuations (NS.SCF), heart rate (HR) and skin temperature (T) were measured. Results: High alexithymia had no effect on the abnormal head posture or movements, but high-alexithymic ST patients showed generally increased levels of autonomic arousal (more NS.SCF, higher SCL; analysis of variance [ANOVA]: P=.016 and P=.051, respectively) under all experimental conditions. When ST symptom severity (TSUI-score) was partialled out, these group differences were somewhat reduced (analysis of covariance [ANCOVA]: P=.052 and P=.143). Conclusions: High alexithymia did not lead to increased abnormal head movements to stressors, but may result in a subtle increase in tonic level of sympathetic activity.