Management of spasmodic torticollis

Colbassani, Harold J.; Wood, James H.

doi:10.1016/0090-3019(86)90285-5

Cited by 28 publications

(12 citation statements)

References 28 publications

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“…Even though sporadic cases mimicking ST have been reported with multiple sclerosis, cerebrovascular disease, encephalitis, carbon monoxide poisoning, syphilis, drug reactions, and systemic dystonia, the etiology of idiopathic adult onset ST has remained an enigma [2,3,12,20,21,22].…”

Section: Discussionmentioning

confidence: 99%

“…have been disappointing [2,3,12,14]. Since Minnius in 1641 performed section of the involved sternocleidomastoid muscle [15], many different operative treatments have been tried such as myotomy, neurectomy, rhizotomy, thalamotomy, spinal cord stimulation, botulinum toxin injections etc., with variable short-term and universably disappointing long-term results [2,3,22].…”

Section: Introductionmentioning

confidence: 99%

“…These physiologic test results would appear to support the hypothesis of a brainstem disorder as pathogenesis of ST. Despite the animal model of a mesencephalic lesion mimicking ST by Foltz et al [4], no such lesion has been documented in human ST by either imaging studies or at autopsy [2,28].…”

mentioning

confidence: 99%

“…In groups of patients not treated surgically, spontaneous cure, significant improvement, or temporary remission of ST have been reported in 10 to 35% of patients [2,3,13]. Herz and Glaser observed three cures, three temporary remissions and six moderate improvements among their 46 patients [9].…”

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confidence: 99%

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Microvascular decompression for spasmodic torticollis

Jho

Jannetta

1995

Acta neurochir

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Twenty patients with spasmodic torticollis (ST) were treated by microvascular decompression (MVD) of the spinal accessory nerves, the upper cervical nerve roots and the brainstem. Thirteen were female and seven male. Median age was 47 years (range 39 to 70 years). Median duration of symptoms was 5 years (range 4 months to 17 years). Ten had right horizontal; nine, left horizontal; and one, retrocollis ST. Twenty-two operations were performed on twenty patients, suboccipital craniectomy and C1 laminectomy in 18 and retromastoid craniectomy in 4 operations. The most common compressing blood vessels were the vertebral artery and/or the posterior inferior cerebellar artery. No nerve section was performed. Three patients died of unrelated conditions, 3, 5 1/2, and 6 years postoperatively, respectively. Minimum follow-up period in the rest of the cases is 5 years (range 5 to 10 years). Thirteen (65%) were cured, four (20%) improved with minimal spasm, one (5%) improved with moderate spasm, and two (10%) improved minimally or unchanged. In most cases the cure or improvement was noticed gradually over 6 months to two years following the operation. There was no operative mortality. Postoperative morbidities included transient cerebrospinal fluid leakage through the surgical incision in one case and an apparent multiple small vessel stroke involving periventricular white matter in one reoperation case with full recovery. MVD for ST is a nondestructive benign procedure with high probability of cure or significant improvement.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Microvascular decompression for spasmodic torticollis

Jho

Jannetta

1995

Acta neurochir

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“…1983) and other post-traumatic movement disorders (Bullard and Nashold 1984). Despite some encouraging reports (Cooper 1969), thalamotomy is now rarely recommended for spasmodic torticollis (Maccabe 1982 andColbassani andWood 1986). …”

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confidence: 99%

The use of thalamotomy in the treatment of levodopa-induced dyskinesia

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1992

Acta neurochir

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Peak dose dyskinesia is a major problem in the treatment of parkinsonian patients with levodopa and yet this remains the best pharmacological agent for treating the condition. The hypothesis which this research set out to test was that thalamotomy in the area of the thalamus which receives the input from the medial segment of the globus pallidus would decrease or prevent the dyskinesia. A well established primate model of parkinsonism was used. Eight monkeys (Macaca fascicularis) were rendered parkinsonian with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Regular dosing with levodopa or apomorphine reliably resulted in peak dose dyskinesia. Thalamotomy was carried out using a radiofrequency electrode. To ensure that the appropriate area of the thalamus was targeted, that is the area receiving the pallidal input, an anatomical tracing study was carried out. The anterograde anatomical tracer horseradish peroxidase, covalently bound to wheatgerm agglutinin, was injected into the medial segment of the globus pallidus bilaterally in three monkeys. The target site for thalamotomy was accurately worked out from the tracings obtained. Chorea was usually abolished and always reduced by a thalamotomy in the pallidal terminal territory. This result was obtained after 10 thalamotomies: 4 animals receiving bilateral lesions, with an interval between operations, and 2 animals undergoing unilateral surgery. Lesions in three control sites were carried out and had no permanent effect on chorea. The effect of lesions in other areas was also assessed. Dystonia was not relieved by any thalamic lesion. Thalamotomy is a long established procedure used to help parkinsonian tremor. Appropriately placed thalamotomy should be considered for the relief of disabling peak dose dyskinesia, which is predominantly choreic, in parkinsonian patients on otherwise successful levodopa therapy.

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