Form Of Torticollis Research Articles

Detection of Newcastle disease virus and assessment of associated relative risk in backyard and commercial poultry in Kerala, India.

BackgroundNewcastle disease (ND) is an economically important viral disease affecting the poultry industry. In Kerala, a state in South India, incidences of ND in commercial and backyard poultry have been reported. But a systematic statewide study on the prevalence of the disease has not been carried out.ObjectivesA cross‐sectional survey was performed to detect the presence of Newcastle disease virus (NDV) in suspect cases and among apparently healthy commercial flocks and backyard poultry, in the state and to identify risk factors for NDV infection.MethodsReal‐time reverse transcription‐PCR (RT‐PCR) was used to detect the M gene of NDV in choanal swabs and tissue samples collected from live and dead birds, respectively and the results were statistically analysed.ResultsThe predominant clinical signs of the examined birds included mild respiratory signs, huddling together and greenish diarrhoea. Nervous signs in the form of torticollis were noticed in birds in some of the affected flocks. On necropsy, many birds had haemorrhages in the proventriculus and caecal tonsils which were suggestive of ND. Of the 2079 samples tested, 167 (8.0%) were positive for the NDV M‐gene by RT‐PCR. Among 893 samples collected from diseased flocks, 129 (14.5%), were positive for M gene with pairwise relative risk (RR) of 15.6 as compared to apparently healthy flocks where 6 out of 650 (0.9%) samples were positive. All positive samples were from poultry; none of the ducks, pigeons, turkey and wild birds were positive. Commercial broilers were at higher risk of infection than commercial layers (RR: 4.5) and backyard poultry (RR: 4.9). Similarly, birds reared under intensive housing conditions were at a higher risk of being infected as compared to those reared under semi‐intensive (RR: 6.7) or backyard housing (RR: 2.1). Multivariable analysis indicated that significantly higher risk of infection exists during migratory season and during ND outbreaks occurring nearby. Further, lower risk was observed with flock vaccination and backyard or semi‐intensive housing when compared to intensive housing. When the M gene positive samples were tested by RT‐PCR to determine whether the detected NDV were mesogenic/velogenic, 7 (4.2%) were positive.ConclusionsIn Kerala, NDV is endemic in poultry with birds reared commercially under intensive rearing systems being affected the most. The outcome of this study also provides a link between epidemiologic knowledge and the development of successful disease control measures. Statistical analysis suggests that wild bird migration season and presence of migratory birds influences the prevalence of the virus in the State. Further studies are needed to genotype and sub‐genotype the detected viruses and to generate baseline data on the prevalence of NDV strains, design better detection strategies, and determine patterns of NDV transmission across domestic poultry and wild bird populations in Kerala.

Muskulärer Schiefhals

Correction of malalignment of the cervical spine with the head tilted to the side of the shortened muscle and rotation to the opposite side due to a contract sternocleidomastoid muscle. Attainment of an increased range of motion of the cervical spine and a better cosmetic appearance. Regression of a facial asymmetry. Contract sternocleidomastoid muscle with deformity intolerable by the patients and their parents. Bony anomalies with consecutive torticollis. Torticollis caused by other muscular contractures (trapezoid muscle). Torticollis due to acute rheumatoid arthritis or other inflammation around the neck. Other forms of torticollis (psychogenic, ocular, vestibular or spasmodic torticollis). In younger children, subcutaneous tenotomy of the distal part of the sternocleidomastoid muscle. At preschool age, additional incision of the deep cervical fascial layer with an open tenotomy. In delayed operations, open distal and proximal tenotomy together with incision of the deep fascial layer or complete excision of the sternocleidomastoid muscle. Until the age of 6 years, application of a Minerva cast after surgery for 6 weeks. Subsequently, physical therapy for 6 months. In children of school age and older people, application of a soft cervical bandage for 6 weeks with functional physiotherapy. In 83 reexamined patients with muscular torticollis, 76 biterminal and seven distal tenotomies had been performed. Regarding the age at the time of operation and the interval to follow-up, an improvement of facial symmetry could be achieved. At the control, 25 patients showed complete recovery of facial asymmetry, 43 had a slight and 15 a severe asymmetry. The complication rate was low with one injury to the external jugular vein and one transient facial nerve paresis. In two patients, passive overcorrection in the cast resulted in transient paresis. Two patients developed a recurrence of muscular torticollis.

Aripiprazole-Induced Acute Dystonia

Back to table of contents Previous article Next article Letters to the EditorFull AccessAripiprazole-Induced Acute DystoniaPUSHPAL DESARKAR M.D., D.P.M.ANUPAM THAKUR M.D.VINOD KUMAR SINHA M.D., D.P.M.,PUSHPAL DESARKAR M.D., D.P.M.Search for more papers by this authorANUPAM THAKUR M.D.Search for more papers by this authorVINOD KUMAR SINHA M.D., D.P.M.Search for more papers by this author,Published Online:1 Jun 2006AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Aripiprazole, the new-generation atypical antipsychotic that is a dopamine system stabilizer, is known for its low propensity to cause extrapyramidal symptoms (1) . Although several reports of dystonia associated with the use of newer atypical antipsychotics are accumulating, a thorough PubMed search through Nov. 6, 2005, did not reveal a single such case induced by aripiprazole. We report a case of acute dystonia observed during aripiprazole therapy. “Mr. A,” an 18-year-old man with no contributory family, past, or personal history was brought to our community clinic with a 4-week history suggestive of a psychotic manic episode. Treatment was initiated with tablet divalproex, which was increased to 500 mg b.i.d., along with aripiprazole, 15 mg/day. In the next follow up, his parents complained about episodes suggestive of dystonia in the form of torticollis, which started within 3 days of treatment initiation. Mr. A did not receive any other medication in between. Trihexyphenidyl, 2 mg/day, was added to the regimen, and dystonia did not recur. Exact mechanism of neuroleptic-induced acute dystonia is still unclear and possibly attributable to a higher ratio of dopamine-acetylcholine antagonism (2) or postsynaptic dopamine hypersensitivity (3) in the basal ganglia. However, preclinical studies with aripiprazole have shown that the drug’s unique partial agonism at dopamine D 2 and serotonin 5-HT 1A receptors, along with antagonism of 5-HT 2A receptors, actually protects against emergence of extrapyramidal symptoms (1) . In our case report, Mr. A had two known risk factors for dystonia, i.e., being young and male (1) . Additionally, we propose the following neurobiological mechanisms that either alone or in combinations could have resulted in acute dystonia with aripiprazole. First, aripiprazole—unlike clozapine, which does not induce acute dystonia—lacks protective anticholinergic action (1) . This was supported by the fact that, in our case, dystonia resolved with anticholinergic medicines. Second, aripiprazole’s action on the D 3 receptor and antagonism of 5-HT 6 and 5-HT 7 receptors is still unknown (1) and could play a potential role. Third, postsynaptic dopamine hypersensitivity was found in bipolar patients (4) , which may be a significant factor. Fourth, the possibility of complex drug interaction of aripiprazole with divalproex cannot be eliminated. Last, preclinical studies found inhibitory action of aripiprazole on serotonin transporter (1) , which could potentially alter dopamine balance in the basal ganglia region. In short, our case report reveals that even aripiprazole may cause rare dystonia in vulnerable individuals, despite having a favorable receptor profile. However, this side effect is amenable to conventional anticholinergic treatment.Ranchi, India Jharkhan, India

Torticollis Associated with Positional Plagiocephaly: A Growing Epidemic

The primary study aim was to identify characteristics of torticollis associated with plagiocephaly without synostosis (PWS) and to differentiate this from other forms of torticollis. The three commonest causes of infantile torticollis are idiopathic muscular causes such as sternocleidomastoid fibrosis, structural anomalies in the cervical vertebrae, and neurologic or ocular causes, such as certain types of strabismus. Recently, several units have reported increasing numbers of babies presenting with head tilt and reduced range of cervical motion, a form of torticollis apparently associated with PWS and unrelated to the etiologies enumerated above. A secondary aim was to identify local trends in referral patterns over the preceding 3 years. This was a retrospective review of 159 children attending a secondary referral center for management of positional plagiocephaly or torticollis. The data was collected in a university-affiliated child development clinic, and the records of one of three similar, community-based outpatient clinics, staffed by physical therapists and working in conjunction with our tertiary craniofacial surgery center were analyzed by medical staff. There was a persistent escalation in referrals for both PWS and associated torticollis (ie, not attributable to 1 of the 3 causes mentioned) over the study period. Anatomic and clinical features of PWS-associated torticollis were characterised and contrasted with the classic forms of torticollis. Current treatment strategies are outlined and discussed. Torticollis can predispose to PWS, but in a large proportion of our cases of PWS, torticollis appears to develop secondary to plagiocephaly, and the number of presentations is escalating.

Natural History of Adult-Onset Idiopathic Torticollis

The rates of spontaneous remission and progression of dystonia to other sites were studied in 72 patients who first presented with adult-onset torticollis, and who were followed up for a mean of 7.7 years. Dystonia had progressed to sites other than the neck (mainly the face and upper limbs) in 23 patients (32%). The latter cases were not differentiated from those with isolated torticollis in terms of any of the demographic or clinical features studied, although they tended to have suffered from torticollis longer. Fifteen patients (20.8%) had experienced a spontaneous remission of their torticollis, which was sustained for a median period of 3 years in 9 cases (12.5%). Eighty-seven percent of the 15 remissions had occurred during the first 5 years of the illness. In the 9 cases with sustained remission, the duration of torticollis before spontaneous remission was significantly longer and remission had mostly occurred after 2 years of illness compared with the 6 who had relapsed. The 15 cases with spontaneous remission tended to have an earlier age of onset compared with those with no remission. Sixty-five percent of cases were correctly classified on the basis of age at onset, which emerged as the only salient variable in the discrimination of the 15 patients with spontaneous remission from the 57 without spontaneous remission. Age at onset, form of torticollis, gender, and direction of head deviation resulted in a correct classification rate of 70%, in the discrimination of the 9 cases with sustained remission from those with no remission.(ABSTRACT TRUNCATED AT 250 WORDS)