Research progress in spasmodic torticollis rehabilitation treatment

Spasmodic torticollis(ST)is a focal dystonia that affects adults,causing limited muscle control and impacting daily activities and quality of life.The etiology and curative methods for ST remain unclear.Botulinum toxin is widely used as a firstline treatment,but long-term usage can result in reduced tolerance and adverse effects.Rehabilitation therapy,with its minimal side effects and low potential for harm,holds significant clinical value.This article explores the effectiveness of adjunctive therapies,including exercise therapy,transcranial magnetic stimulation,shockwave therapy,neuromuscular electrical stimulation,vibration therapy,electromyographic biofeedback,and acupuncture,in the treatment of ST.The aim is to provide clinicians with additional treatment options and to discuss the efficacy of rehabilitation therapy for ST.

Atlanto-axial langerhans cell histiocytosis in a child presented as torticollis

Langerhans cell histiocytosis(LCH) is a rare condition mostly seen in children and adolescents. Eosinophilic granuloma(EG) is one of its three clinical entities and is considered as a benign osteolytic lesion. Many reports of patients with spine histiocytosis are well documented in the literature but it is not the case of atlantoaxial localization. We report here a new observation of atlantoaxial LCH in a 4-year-old boy revealed by persistent torticollis. He was successfully treated with systemic chemotherapy and surgery. Inter-body fusion packed by autologous iliac bone was performed with resolution of his symptoms. It is known that conservative treatment is usually sufficient and surgery should be reserved for major neurologic defects in spine EG. In atlantoaxial lesion, surgical treatment should be frequently considered.

The status of the cervical spine in preschool children with a history of congenital muscular torticollis

Background: Infants with congenital muscular torticollis are born with an asymmetric range of motion and a muscular imbalance in the cervical spine, as a result of a shortening or excessive contraction of the sternocleidomastoid muscle. Purpose: The study aimed to investigate passive range of motion (PROM) for rotation and lateral flexion, and muscle function of the cervical spine in children that had a history of CMT as infants. Study design: a prospective cohort study. Patient sample: 58 children at the age of 3.5 to 5 years that had been treated for CMT have infants participated in the study. Method: PROM was measured with protractors and muscle function was estimated with a modified Muscle Function Scale. Data from infancy were taken from earlier records. Result: PROM in rotation of the neck was mean 98.7&#176 and PROM in lateral flexion of the neck was mean 69.1&#176. Symmetric PROM of the neck was found in 74% of the children for rotation and in 88% of the children for lateral flexion. Multiple regression showed that gender and PROM in rotation as infants had a significant impact on asymmetric PROM. Forty-five percent of the children had some degree of muscular imbalance in the lateral flexors of the neck. Conclusion: Possible risk factors for later asymmetric PROM are: gender, birth weight, gestation week and PROM in rotation as infants. These factors ought to be taken into consideration when developing guidelines for long-term follow-up.

Tuina massage combined with traditional Chinese prescription improves quality of life and motor symptoms in a spasmodic torticollis patient:A case report

Objective:A case study was performed to discuss the efficacy of traditional Chinese medicine(TCM)treatments on spasmodic torticollis.Materials and methods:A 28-year-old male was diagnosed with spasmodic torticollis due to twist and turn of neck after being frightened,who was unable to take care of himself for over 3 months.He once took an oral non-steroidal anti-inflammatory drug,but no significant improvement was seen in his symptoms.After a few months,his symptoms got worse,with onset of spasms.Therefore,he was treated at our hospital with traditional Chinese prescription and Tuina massage therapy for 3 months and followed up for 6 months.The Toronto Western Spasmodic Torticollis Rating Scale(TWSTRS)and the Craniocervical Dystonia Questionnaire(CDQ-24)scores were recorded before and after treatment and during follow-up observations to evaluate the therapeutic efficacy.Results:Compared to the baseline,the TWSTRS and CDQ-24 scores decreased significantly,and there was no evident recurrence of his symptoms for at least 6 months of follow-up.Moreover,no apparent discomfort or side effects were observed during the treatment.Conclusion:Jingu abdominal massage combined with traditional Chinese prescription has a certain efficacy in the treatment of spasmodic torticollis,with almost no side effects,which can be easily accepted by patients.

Modified Foerster-Dandy 's operation for treatment of spasmodic torticollis under endoscope-assisting

Objective To study microsurgical effectiveness Foerster-Dandy’s endoscope-assisted operation for treatment of spasmodic torticollis. Methods 183 cases of spasmodic torticollis patients were treated by microsurgical modified Foerster-Dandy’s operation from July 2001 to June 2009,which was randomly

Acupuncture for 40 cases of spasmodic torticollis

Objective To evaluate the clinical effectiveness of professor WU Lian-zhong＇s ＂resuscitation and regulating muscle＂ acupuncture method for spasmodic torticollis（ST） based on syndrome differentiation,and to compare the efficacy of acupuncture treatment between the patients with spasmodic torticollis who were not given botulinum toxin A by injection and the patients given botulinum toxin A by injection.Methods Forty patients were divided into treatment group（not given botulinum toxin A by injection） and control group（given botulinum toxin A by injection）,with 20 patients in each group.＂Resuscitation and regulating muscle＂ acupuncture method was adopted in both two groups,and the treatment lasted for 6 months.The clinical efficacy in both two groups was compared after treatment.Tsui＇s Scale was applied to evaluate the overall effect,the abnormal posture of cervical spine and dystonic tremor.Toronto Western Spasmodic Torticollis Rating Scale（TWSTRS） was used for scoring the severity of torticollis,quality of life and pain.Results After treatment,the markedly effective rate and the total effective rate in treatment group were 35.0% and 90.0%,respectively,which were superior to those in control group,namely 20.0% and 75.0%,and the efficacy difference was statistically significant for the total effective rate（P0.05）.It was shown according to the Tsui＇s Scale and TWSTRS that the differences were statistically significant when compared the two groups before and after treatment（all P0.01）;the difference of intergroup comparison after treatment was statistically significant（P0.05）.No adverse effect was found in both two groups during acupuncture treatment.Conclusion ＂Resuscitation and regulating muscle＂ acupuncture method can effectively improve the clinical symptoms of ST patients,and better efficacy is found in the patients not given botulinum toxin A by injection.The course of treatment of acupuncture treatment for torticollis patients is longer,and the patients should insist on treatment,and keep a good attitude.

Acupoint magnetic therapy in the treatment of spasmodic torticollis

Objective To observe the clinical efficacy of acupoint magnetic therapy for spasmodic torticollis. Methods Twenty patients with spasmodic torticollis were treated by acupoint magnetic therapy at Fengchi （风池 GB 20）, Dazhui （大椎 GV 24） and Shenzhu （身柱 GV 12）. Once a day, ten days as a course of treatment, 24 treatments were given. Results Six cases were cured and 9 cases were markedly effective, 3 cases were effective and 2 cases were ineffective with the cured rate of 30% and the effective rate of 90%. Conclusion Acupoint magnetic therapy has sound effect in the treatment of spasmodic torticollis.

Quick-impact Tuina for 38 cases of pediatric muscular torticollis

Objective To observe the therapeutic effect of quick-impact Tuina method on treatment of pediatric muscular torticollis.Methods Pushing,kneading,and grasping manipulations combined with traction and flicking method were applied at sternocleidomastoid on the affected side for 38 cases of pediatric muscular torticollis.The treatment was given 1 time a day,10 times as a course.The therapeutic effect was evaluated after 3 courses of treatment.Results Thirty-four cases was evaluated as full recovery,3 cases as remarkable effectiveness,1 case as effectiveness,0 case as ineffectiveness,the total effective rate was 100.0%.Conclusion The combined method treating pediatric muscular torticollis regulated tendons and relieved blood stasis,improved muscular spasm,and dispersed mass,so as to enhance and restore the regular neck function with significant therapeutic effect.

Comparison of curative effect of different media in pediatric tuina for infantile muscular torticollis

Objective:To observe the clinical efficacy of different media in pediatric tuina treatment for children with muscular torticollis.Methods:A total of 80 children with muscular torticollis were randomized into an observation group and a control group,40 cases in each group.Both groups received conventional pediatric tuina therapy.The observation group was treated with Bai Mai ointment as the massage medium,while the common lubrication oil was used as medium in the control group.Both groups were treated five times a week,20 min for each time,20 times constituted a course of treatment.The traditional Chinese medicine(TCM)syndrome scores were evaluated before and after treatment,and the curative effect was observed after 3 courses and 6 courses of treatment respectively.Results:The TCM syndrome scores improved in both groups after treatment,and the intra-group differences were statistically significant(both P〈0.01).The score of the observation group was statistically different from that in the control group(P〈0.05).In the observation group,the total effective rates after 3 courses and 6 courses of treatment were 95.0%and 100.0%,respectively,versus 87.5%and 95.0%in the control group.The total effective rates of the two groups were statistically different(both P〈0.05).Conclusion:Bai Mai ointment has a better curative effect than the common lubricating oil as a massage medium in the treatment of children with muscular torticollis.

Clinical Observation on Tuina Therapy for Congenital Muscular Torticollis

Objective:To observe the clinical effect of spleen-strengthening and kidney-benefiting tuina therapy for congenital muscular torticollis.Methods:A total of 63 cases who met the inclusion criteria were randomly allocated into an observation group and a control group.Cases in the control group were treated with tuina manipulation on the local area,whereas cases in the observation group were treated with local tuina plus manipulation that acts to strengthen the spleen and benefit the kidney.Cases in both groups were treated three times a week,20 times for a course of treatment.The clinical effects were observed after three courses.Results:There was no between-group significant difference in the total effective rate.However,the recovery and marked effect rate in the observation group was 63.3%,versus 33.3%in the control group,showing a significant difference(P<0.05).Conclusion:Combining local tuina with spleen-strengthening and kidneybenefiting tuina manipulation could obtain better effect in congenital muscular torticollis than local tuina alone.

Tuina for infant congenital muscular torticollis:A randomized controlled trial

Objective:To compare the differences in the clinical effect of congenital muscular torticollis between the modified tuina(Chinese massage)manipulation and the textbook-version tuina manipulation in infant.Methods:From January 2017 to December 2018,68 infants with congenital muscular torticollis were collected from the Department of Acupuncture-Moxibustion of the Affiliated Hospital of Yanbian University.They were randomized into a modified tuina group and a textbook-version tuina group,34 cases in each one.In the modified tuina group,the infants were treated with the stroking and circular kneading manipulation,200 times,the plucking manipulation,500 times and the modified rolling manipulation,500 times.In the textbook-version tuina group,the infants were treated with the tuina for muscular torticollis described in Tuina,in the sequence of the circular kneading for 5-6 min,the pinching and grasping for3-5 min,neck traction for several times,the pushing and circular kneading for 3-5 min and gently holding Jianjing(肩井GB21)for 3-5 times.In each group,the treatment was given once every day and there was 1-day rest after every 6-day treatment.Totally,the duration of treatment was 60 days.Separately,before treatment,in 30 days and 60 days of treatment,the lump diameter and the infants'adaptability were observed and compared between the two groups.Results:The effective rates were 94.1%and 70.6%in the modified tuina group and the textbook-version tuina group respectively,presenting a significant difference(P<0.05).In 30 days of treatment,12 cases were cured in the modified tuina group and 7 cases in the textbook-version tuina group.In 60 days of treatment,the color Doppler ultrasound examination found that the lump diameter in the modified tuina group was obviously smaller than that in the textbook-version tuina group,indicating a significant difference(P<0.05).During the treatment,there was no case dropped out in the modified tuina group,but in the textbook-version tuina group,because of crying and low adaptability during treatment,2 cases were dropped out.Conclusion:The modified tuina manipulation achieves the satisfactory clinical effect on infant congenital muscular torticollis and it is acceptable by the infant.Hence,this therapy deserves to be promoted in clinical practice.

Tuina plus Ultrasonic Therapy for Infantile Muscular Torticollis

Objective: To observe the clinical efficacy of tuina plus ultrasonic therapy in treating infantile muscular torticollis. Methods: Seventy kids with muscular torticollis were intervened by tuina plus ultrasonic therapy, and the efficacy was evaluated after 8-month treatment. Results: After 8-month treatment, 41 subjects were cured, accounting for 58.6%, 27 were improved, occupying 38.6%, 2 failed, occupying 2.8%, and the total effective rate was 97.2%. Conclusion: Tuina plus ultrasonic therapy can produce a significant efficacy in treating infantile muscular torticollis, without adverse effects.

Sandifer’s Syndrome in a 3-Month-Old Male Infant: A Case Report

Background: Sandifer syndrome (SS) is the association of gastroesophageal reflux disease (GERD) with neurological manifestations (spastic torticollis and paroxysmal dystonic postures with arching of the back and rigid opisthotonic posturing. Case presentation: A 3-month-old male infant presented to our emergency department with torticollis and dystonic episodes for two months associated with vomiting. These movements were observed during or just after feeding. Since the patient developed regurgitations with torticollis and dystonic episodes with arching of the back and rigid opisthotonic posturing. The electroencephalogram was normal. Barium swallow/meal examination revealed GERD without evidence of hiatus hernia. Apgar scores were 7 at 1 min and 9 at 5 min. Conclusion: Early recognition and treatment of GERD in patients with Sandifer syndrome enhance the success of medical management and contributes to improved quality of life for patients with brain damage. The paroxysmal dystonic behaviors were dramatically disappeared completely after medical management in this patient.

Conservative Treatment in Grisel’s Syndrome Following Tonsillectomy

Grisel’s syndrome is a rare complication that is characterized by non-traumatic atlantoaxial subluxation. It is most commonly seen in children after an upper respiratory tract infection or neck surgery, such as an adenoidectomy, tonsillectomy and mastoidectomy. Grisel’s Syndrome is characterized by torticollis and a limited range of motion of the neck with pain. Here the authors report a case of a Malian 5-year-old girl with Grisel’s syndrome following tonsillectomy. The patient’s complaints were fully resolved after 2 weeks of conservative treatment.

Ocular Manifestations Encountered in Albinos Living in Libreville: Epidemiological and Clinical Aspects

Introduction: Albinism is a rare hereditary genetic disorder, characterized by melanogenesis disorders associated to varying degrees of cutaneous, atrial and visual disorders. In Libreville, no data on the subject is available. Purpose: To describe the ocular manifestations found in albinos living in Libreville. Patients and methods: This was a cross-sectional and descriptive study that took place in Libreville during a year from and that concerned 43 albinos. The inclusion criteria were any albino with oculocutaneous albinism present in Libreville who has agreed to participate in the investigation. The variables studied were age, sex, visual acuity, ametropia, iris color, iris transillumination, strabismus, nystagmus, torticollis, amblyopia, optic disc, photophobia, foveal hypoplasia and retinal hypopigmentation. Data was collected and analyzed using Epi infoTM 7.2.0.1 CDC and?IBM&#174?SPSS&#174?V21 Statistic software. Results: The mean age was 21.2 ± 17 years with a (F/M) ratio of 0.53. Visual acuity by far without correction (AVLCSC) < 3/10 was found in 88.4% of cases. Astigmatism, two-tone iris and torticollis were found respectively in 52.7%, 51% and 26% of cases. Retinal hypopigmentation and foveal hypoplasia were noted in 65.1% and 86% of cases. Divergent strabismus was noted in 71.4% and small and pale papilla in 95.1% of cases. Photophobia, iris transillumination, nystagmus and amblyopia were noted in 100% of cases. Conclusion: The ocular manifestations encountered in our series are similar to those described in literatures.