„Cases against KiSS”: Ein diagnostischer Algorithmus des frühkindlichen Torticollis

Abstract

In 1991, Biedermann coined the term "kinetic imbalance due to suboccipital strain" ("KiSS-syndrome"). He assumed a functional abnormality of the suboccipital-high cervical spine, resulting in positional preference of the infant;s head. A broad spectrum of symptoms and complaints have been attributed to "KiSS-Syndrome". Patients are advised to undergo manual therapy, with pressure applied locally in order to readjust the cervical spine. Life threatening side-effects have been published repeatedly. We present two infants with brain tumours who developed torticollis and further neurological findings such as ataxia and reflex differences. In both cases, symptoms caused by the tumour were interpreted as "KiSS-syndrome", and appropriate diagnostics and therapy were delayed for months. There is no scientific evidence for the actual existence of "KiSS-syndrome" as a clinical entity or for the positive effects of manual therapy. Approximately 12% of all infants <12 months show a positional preference of the head, about 8% present with body asymmetry. Whereas most cases are benign, there is a long list of serious differential diagnoses for torticollis in infants. We give an updated review of the literature regarding "KiSS-Syndrome" and discuss the differential diagnostics in infants with torticollis.

Spinal manipulation and mobilisation in paediatrics – an international evidence-based position statement for physiotherapists

“…While upper cervical dysfunction – KISS-syndrome is purported to be caused by birth trauma [ 53 ] creating an upper cervical fixation, other factors such as testosterone level in male fetuses may accentuate muscular action and the occurrence of congenital torticollis [ 47 ]. Additionally, differential diagnosis is needed to rule out more serious and confounding diagnoses causing congenital torticollis such as tumor, extra muscular masses, fractured clavicle, neurological damage (e.g., cerebral palsy, brachial plexus injury), osteogenic asymmetry, and craniosynostosis as well as to rule in associated congenital muscular torticollis and plagiocephaly [ 54 ]. Early identification of infants at risk of congenital muscular torticollis and head asymmetries is essential; the rate of correction for cranial asymmetry decreases as the infants grows older (>3-months) as they gain head control and can reduce time with pressure on the occiput [ 55 ].…”

Manipulasjonsteknikker ved nakkeasymmetri hos spedbarn

“…Happle og medarbeidere beskrev to spedbarn som ble diagnostisert med nakkeleddsinduserte symmetriforstyrrelser og behandlet med manuellterapi og fysioterapi (24). Symptomene vedvarte etter endt behandling, hvorpå videre utredning viste at symptomene skyldtes kreftsykdom.…”

“…Det finnes anekdotisk dokumentasjon for at manipulasjonsbehandling har ført til skade blant voksne pasienter (31). Det er også dokumentert skade blant barn, men da i forbindelse med at det er gitt manipulasjonsbehandling til pasienter som har vaert mangelfullt utredet (24,25). God diagnostikk og utredning er viktig for å unngå forsinkelser i behandlingsforløpet og for å unngå forverring av underliggende sykdom (32,33).…”