Brain, Vol. 124, No. 1, 47-59,
January 2001
© 2001 Oxford University Press
Abnormal interaction between vestibular and voluntary head control in patients with spasmodic torticollis
1 Medical Research Council Human Movement and Balance Unit, National Hospital for Neurology and Neurosurgery, 2 Department of Clinical Neurology, Institute of Neurology, University College London, London, 3 Department of Neurosurgery, Derriford Hospital, Plymouth, Devon, UK, 4 `Salvatore Maugeri Foundation' Division of Physical Therapy and Rehabilitation, IRCCS, Veruno, Novara, Italy and 5 Department of Neurology, Rostock University, Rostock, Germany
Correspondence to:
Adolfo M. Bronstein, Medical Research Council, Human Movement and Balance Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK E-mail: A.Bronstein{at}ion.ucl.ac.uk
The functional status of vestibulo-collic reflexes in the sternocleidomastoid (SCM) muscles was investigated in 24 patients with spasmodic torticollis using small, abrupt `drops' of the head. None had been treated with botulinum toxin injections during at least 4 months preceding the study. Eight of the patients, four of whom had been studied before surgery, were also studied after selective peripheral denervation of neck muscles. The reflex was of normal latency and duration in the `passive drop' condition, in which subjects were instructed not to oppose the fall of the head. To study voluntary interaction with the reflex response, subjects were then asked to flex the neck as quickly as possible after onset of the head drop (`active drop'). In this condition, voluntary responses in patients were delayed, smaller and less effective in counteracting the head fall than in normal subjects. The same abnormalities were also found in patients after surgery when the head posture was improved. Somatosensory/auditory voluntary reaction times in SCM were normal, as was the latency of the startle reflex. We conclude that voluntary interaction with the vestibulo-collic reflex is disrupted in patients with spasmodic torticollis, a finding which corroborates the patients' aggravation of their symptoms by head or body perturbations. Lack of effective interaction between two major systems controlling head position may contribute to torticollis.
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