11:05,27,Aug,2007 | (544/0/0) | Original

treatment for spasmodic torticollis


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treatment for spasmodic torticollis

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Disease introduction is a kind of spasmodic torticollis or clonic neck muscle to reverse the tilt of extrapyramidal organic disorder characterized. Slow onset of clinical manifestations, involuntary head rotation to one side, then to the other side of the neck flexion. Can be aggravated by emotions, sleep, completely disappeared. The more common diseases in adults, the cause is unknown so far, modern Western medicine
Spasmodic torticollis - there is no effective therapy imaging, drugs and surgery are imprecise. According to Nutt and other reported in the literature, the prevalence of spasmodic torticollis is about 9 / 10 million. The incidence related to gender and age, women are usually men, the incidence of 1.5-1.9 times. The peak age of onset 50-60 years, 70% -90% of patients between the ages of onset in 40-70. Disease varied from mild or occasional episodes to treatment with different difficulty levels. The disease sustainable life, and can lead to restricted movement disorders and postural deformities. Course of the disease is usually slow, 1-5 years were stagnant. About 10% -20% of patients within 5 years after the onset can be spontaneous recovery, usually mild disease who are young .1 / 3 of patients have other parts of the performance of dystonia, such as the eyelids, face, jaw or hands, involuntary movement (such as seizures) in sleep may disappear. in ancient medical books, acupuncture treatment has not yet found a similar record of this disease. Acupuncture treatment of spastic torticollis modern reports, started in the 70s, with local call-in acupuncture needle puncture plum, cured in 2 cases. But the main clinical data, basically found in the 80's, the experience except a few cases outside of government, and more cases are observed. Point stimulation method, the use of acupuncture, electroacupuncture and resonance electrical sparks, and acupoint stimulation induction. Especially the latter, not only the number of cases observed more, and the effect is very obvious. In view of this rare clinical disease, acupuncture treatment is a matter in recent years, so the clinical treatment of the law has yet to be explored further. The cause of disease etiology of this disease is not clear, patients may have a family history, a few secondary to encephalitis, multiple sclerosis, carbon monoxide poisoning, but most of them no cause. Its pathogenicity
Spasmodic torticollis causes, central and peripheral two kinds of speculation. May be the central cause of frontal and parietal cortical atrophy (Karte, etc., 1981), the Ministry of damage in the brain was covered (Foez), or cause the system interstitial nucleus of the thalamus (Hassler), or basal ganglia lesions, etc. (Cassirer, Foester, Firnforsch ) caused. Also suggested that with the neurotransmitter related. 5 - reduce the concentration of serotonin can cause head and neck rotation, reduce the concentration of catecholamines may lead to tonic neck deviation and so on. Treckmann (1981) based on Jennetta theory that the cause may be peripheral nerve microvessels of oppression, that is, the long-term nerve compression by the vascular changes produce local demyelination, the eccentric and short circuit between the fibers, causing the accumulation of abnormal impulse muscle contraction resulting from the head, but is not currently recognized. Pathological mechanisms of spastic torticollis exact pathological mechanisms are not yet clear, may be associated with the following aspects: genetic factors in some adult onset dystonia is localized genetically determined. Traumatic injury has been considered the cause of spasmodic torticollis, 9% -16% reported in the literature of patients with previous history of head or neck trauma, usually occurs before the onset of several weeks to several months. Vestibular dysfunction in patients with spasmodic torticollis has been reported vestibular - ocular reflex response of higher or asymmetry, in the use of botulinum toxin treatment can not be corrected. Exception is not within the primary vestibular abnormalities, other types of focal dystonia (such as: writer's cramp, blepharospasm) can also be associated with spasmodic torticollis with. Deafness, vertigo and ataxia are not characteristic of spasmodic torticollis. Also, many patients do not vestibular reflex abnormality, and a longer time spasmodic torticollis, which may vestibular abnormalities caused by spasmodic torticollis secondary to long-term abnormal head posture. Other short-term or prolonged vibration stimulation of the neck showed changes in head position in patients with obvious differences, this is due to sensory stimulation changed around the body, so that central control of compensatory head and neck to reverse the mediation function involved, the central afferent nerve impulses that barriers to integration. Clinical manifestations 1. The degree of spastic torticollis can be divided into mild, moderate and severe degrees. The range of light by small muscle spasm, only unilateral attack, no muscle pain; medium of Bilateral seizures, mild muscle pain; heavy are not just bilateral carotid
Spasmodic torticollis muscle was dragged, and the adjacent muscles, such as the shoulders, face, chest and back muscles tends to spread ministers, and serious muscle pain. 2. The clinical manifestations of spastic torticollis can be divided into four types. (1) rotary type: head to the side to do around the longitudinal axis of the body or clonic spasm rotation. According to whether the tilt head and the vertical axis can be divided into three subtypes: the level of rotation, backwards rotation and flexion rotation. Rotary is the most common form of this disease type, of which slightly more common type backwards, horizontal, followed by flexion-type less. Moreover, according to the case of muscle contraction, can be divided into two kinds of spasms and clonus. The former head of patients with persistent stiffness in rotation to one side; to swing the latter was frequently moving. (2) heads off type: patients or clonic spasm head thrown back, face heavenward. (3) flexion type: do patients with head to the chest or clonic spasm of flexion. (4) side of the twin type: patients with head deviation from the vertical axis to the left or right turn, critically ill patients in the ear, temporal approach, or closely aligns with the shoulder, and often accompanied by the phenomenon of ipsilateral shoulder elevation. Onset of disease, according to the patient more easily identify
Diagnosis of spastic torticollis, but should identify with the following diseases. 1. Hysterical torticollis spirit of pathogenic factors of onset of a sudden, head and neck is very dynamic, with no fixed rules, the hint, the symptoms may ease with the emotional stability. 2. Torticollis secondary to cervical nerve tumors, injury, osteoarthritis, cervical tuberculosis, can cause the disease. Cervical disc herniation, occipital neuritis, due to cervical nerve and muscle irritation, leading to tonic torticollis. Side of the semicircular canal stimulation lost by torticollis, balance disorder caused by congenital eye ocular torticollis, congenital malformations caused by cervical bone torticollis, congenital contracture of the sternocleidomastoid muscle and cerebellum the fourth ventricle tumor torticollis caused by early and so there was no clonus as the identification, etiology needs further examination. Drug therapy treatment of disease, including dopamine drugs, dopamine receptor
Spasmodic torticollis - the treatment agonist, dopamine receptor blockers, excluding short-term dopamine agents, anti-cholinergic agents, GABA can be medicine. Toxin injection with sausages affected muscle cramps, have a certain effect, when no cure. Surgery (1) cervical ventral root, nerve root rhizotomy: also known as Foester-Dandy operation. Cut on the side of the neck under a microscope, 1-3 ventral root and vertebral artery in the plane cut off the nerve root. Not satisfied after surgery, could further cut in the neck nerve branch lesion side. It was reported that about 70% of patients had improved, but 1 / 3 of patients with loss of self-rotation ability of the head; 1 / 3 of the patients had dysphagia. (2) stereotactic surgery: cervical muscle spasm over the scope or application of other treatment effect is not significant, could undermine the use of this procedure ventrolateral nucleus of the medial hypothalamus. Hassler to do so on the level of disruption ForelH hypothalamus rotating beam operation; of rotation or tilt-type is the destruction of their former nuclear ventral (VA) and the globus pallidus and substantia nigra - thalamic afferent fibers, efficacy up to 36% -73%. But the surgery can lead to paralysis, aphasia, ataxia and other complications, is now rarely used. (3) Select the type of neck muscle and nerve transection: (1981) suggested that different types of spasmodic torticollis, the head posture is composed of the relevant muscle contraction, rather than the result of the neck all the muscles involved. Just for the surgical treatment of these major muscles, there is no need to cut off bilateral cervical nerve root and nerve roots, to avoid unnecessary complications. And proposed, on the rotary torticollis can be removed only the first clip muscle ipsilateral and contralateral nerve; on backwards type of torticollis, so part of the trapezius muscle with the surgical removal of the first clip muscle, head and neck semi-spinal muscle ; of flexion-type torticollis and cut off bilateral nerve; type of scoliosis torticollis, the head bent sideways to do the first folder muscle, levator scapulae, sternocleidomastoid individual patients if the ipsilateral spasm can also be added the vice neurectomy. Spasmodic torticollis (4) Select the type of peripheral nerve surgery: This method is mainly cervical nerve root after cutting branches off the range of options based on the amount of spastic muscles. The reason is that all the whole back of the neck muscles from the cervical dorsal rami dominated 1-7. If the condition of patients, you can always cut to the neck 7. The surgical method of rotating torticollis have a certain effect. (5), nerve root microvascular decompression: open the foramen magnum and upper cervical spinal canal. Observed under an operating microscope around the availability of bilateral nerve root compression of its blood vessels, nerve blood vessel is usually the vertebral artery, posterior inferior cerebellar artery or spinal cord artery, cutting off the premises after confirmation dentate ligaments, the nerve and vascular compression between the cotton pad into the Tefleon so separated. Recent operations have a certain effect, long-term efficacy remains to be seen. At present, the clinical manifestations and electrophysiological examination to determine the form and the involvement of muscle spasm, individualized surgical planning, inspired by the subject after the surgery cerebral palsy, surgery through improved FD method, achieved remarkable results, 22 cases by surgical treatment, effective rate is 86%. EA treatment (a) acupoints main point: day capacity, later, sunroof, arm Er. Distribution Point: Yang Bai, Hegu. Later point in: the mandibular angle behind the ear lobe straight down to 1.5 inches at the post-depression. (B) cervical muscle spasm Therapeutic each taking a more prominent main points of the ipsilateral neck and bilateral arm Er a hole, the other points as appropriate, to take with a (same side). Main points and distribution points the neck, acupuncture Entering the gas, briefly lift and thrust Twist, turn on EA instrument. Among them, the neck hole then negative, then positive with points. Specific requirements are as follows: day capacity points, piercing the 5 to 8 minutes, power head to the acupuncture needle rotation and ipsilateral side of shrugging movement; later: perpendicularly 0.5-1 inch, electric needle to the needle side of the rotating head; Skylight: piercing obliquely upwards of 5 or 1 inch, EA
Spasmodic torticollis and the hour hand side of his head and shrugging movements. Er arm hole, inward obliquely below the 1.5-inch, until there is a sense of soreness and so have gas after twisting with a small lift and thrust for the needle for 1 minute, needle retention, will not receive acupuncture. Power or time is 20-30 minutes of needle retention. 1 day or every other day. 15 times as a course of 3-5 days cured by needle to the next course of treatment. (C) Evaluation of rule of law for a total of 8 cases, the results were recovered. 4 cases, after 7-9 years of follow-up, neither recurrence. Acupoint electrical stimulation (a) of the acupoints main point: the wind pool, shoulders well, Futu. Distribution Point: Baihui, Hegu, sleep. (B) of the Therapeutic mainly resonance and induction electric sparks to stimulate acupuncture points. The main point of spasmodic torticollis, according to disease type and selection of different: horizontal rotation to take all three points; get help after the sudden flexion type, flexion and shoulder-type well take the wind pool. First to sense electrical stimulation. Line with common sense part of the electrical stimulation machine, the output is 0-18V AC. Where a block is 3V, 2 block 5V, 3 block 9V, 4 blocked 15V, 5 blocked 18V; frequency of 60-80 Hz, irregular needle-shaped wave. Induction electric treatment, while the two handles placed on two points, and with intermittent electricity for treatment. Stimulation as follows: horizontal rotary patients with spasmodic torticollis, first placed in double Fengchi, intermittent power 3 minutes; downward slide Jianjing Xue, intermittent power 3 minutes; and then, suddenly came alive again placed in double-Fu Point, intermittent power for 1-2 minutes, and to guide patients to make head movements, and then 2 minutes at the power point. After the bend-type patients, while the two handles placed Futu hole, intermittent power for 5 minutes, guiding patients for head movement, and then repeat the method 1. Flexion-type patients, the first two placed in double Fengchi handle, intermittent power 3 minutes, slide down to double-Jian Jingxue, power 3 minutes. Power, the guidance of the patient for head movement, and then click on the Law of Repeat 1 times. Induction electric acupoint stimulation, the beginning of the first transferred to 3V, then gradually
Acupoint electrical stimulation increased, until the muscle contraction apparent until the patient can tolerate. Then echo spark treatment. Fork or small round-shaped electrode to electrode contact point on. Stimulation of acupuncture points for the main points and distribution points the wind pool. The moderate dose for adults, the elderly or children, the weak stimulation. Stimulation of 3 minutes per hole. In addition to the points outside the wind pool use double points, sleep, Hegu are single points (contralateral or ipsilateral), such as patients with insomnia, then change the two-sleep points. Spark induction power and resonance to stimulate acupuncture points, 1 day ,15-20 times for one course of treatment. Treatment interval of 3-5 days. (C) Evaluation of efficacy criterion: cured: disappearance of abnormal motion of head and neck and neck in any direction to do self-movement, partial return to normal muscle hardening; markedly: abnormal movements of head and neck disappeared or almost disappeared, when the occasional fatigue or tension ; effective: reducing the number of abnormal motion of head and neck, amplitude decreases. Treatment
of more than 42 cases assessed by the above criteria: cured 40 patients (95.2%) were cured, 1 patient (2.4%), effective 1 (2.4%), total effective rate was 100%. Disease prevention of the disease as the cause is unknown, hence there is no effective preventive measures. The main clinical treatment is active. Physical therapy and massage can sometimes temporarily relieve cramps, for example, while in the first rotation imposed on the same side of jaw may feel mild pressure (feeling of biofeedback techniques). Although drug to inhibit movement dystonia effective rate was 25% -33%, but its role better pain relief. Anticholinergic drugs (such as trihexyphenidyl, benzyl care products) and benzo nitrogen Zhuo class of effective. Muscle relaxants (eg baclofen) and cyclic antidepressants (eg amitriptyline) less use. Small doses of these drugs should be started and gradually increased to an effective, safe level, pay attention to their side effects, particularly in the elderly should be careful.
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