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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We are reporting the cases of five patients who had occipito-atlantal instability, a rare condition that may be due to either trauma or congenital abnormalities. In three of the patients the instability was secondary to trauma. The clinical and neurological manifestations were varied and included cardiorespiratory arrest, motor weakness, quadriplegia, torticollis, pain in the neck, vertigo, and projectile vomiting. All of the patients underwent posterior arthrodesis of the occiput to the first or second cervical vertebra. In the patients who had trauma-related instability, surgery was performed when immobilization in a cast failed to stabilize the spine; in the patients who had a congenital abnormality, arthrodesis was indicated because of persistent symptoms and the potential for catastrophe with minor trauma. Based on our experience, we recommend surgical stabilization by posterior arthrodesis when this form of instability of the cervical spine is diagnosed.
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PMID:Occipito-atlantal instability in children. A report of five cases and review of the literature. 381 5

This report presents our observations in 63 patients undergoing chronic spinal cord stimulation for treatment of spasmodic torticollis. In this series there were 23 patients (36.5%) who demonstrated marked improvement, characterized by no evidence of torticollis, full range of motility of the head and neck and no pain. Moderate improvement was found in 20 patients (31.8%) who showed minimal residual torticollis, but had full motility and no pain. There were 5 patients (7.9%) considered mildly improved who demonstrated decrease in their torticollic position, spasms and pain, but retained some element of torticollis and/or some limitation of motility. Correlations were made demonstrating the effect on the results of age, sex, electrode array, the configuration of the applied field and the parameters of stimulation.
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PMID:Spinal cord stimulation in the treatment of spasmodic torticollis. 387 94

Four years' experience with electrical stimulation of the cervical cord is reported for 18 patients suffering from spasmodic torticollis. Permanent 1,100-Hz stimulation of the C2-C4 level resulted in a marked improvement in 50% of the patients, in a satisfactory result in 27.8% and in an unsatisfactory result in 22.2%. Muscular tension and related pain were reduced within 8 days to 4 months postoperatively. A measurable improvement of head posture rendered objective by a mechanoelectrical measuring device could only be observed after a continuous stimulation over 8-12 months. The procedure is nondestructive and reversible, complications consisted only in those related to the stimulation system itself.
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PMID:Bipolar spinal cord stimulation for spasmodic torticollis. 387 95

One hundred and twenty-one patients with juvenile rheumatoid arthritis were studied clinically and roentgenographically for evidence of disease of the cervical spine. None of the fifty-seven patients with pauciarticular-onset juvenile rheumatoid arthritis had cervical symptoms or signs, and only one had minor roentgenographic changes of disease in the cervical spine. In contrast, clinical stiffness and roentgenographic changes in the cervical spine occurred commonly in the fifty-one patients with polyarticular-onset disease and in the thirteen patients with systemic-onset disease. Despite extensive roentgenographic involvement of the cervical spine, however, pain in the neck was not a common complaint. Neither severe pain in the neck nor torticollis, occurring either separately or concomitantly, is frequently found in patients with juvenile rheumatoid arthritis, and its presence may suggest an intercurrent problem such as a fracture or infection. As patients with juvenile rheumatoid arthritis rarely have disease in the cervical spine alone, the patient should be carefully examined for involvement of multiple joints.
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PMID:Changes in the cervical spine in juvenile rheumatoid arthritis. 394 57

Dystonic torticollis has been treated with local injections of botulinum toxin in a single blind study of 12 patients. A significant decrease of abnormal movements was recorded, and pain improved. Further studies are desirable to define the optimum dosage and site for injections, and the long term effects of repeated injections.
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PMID:A pilot study on the use of botulinum toxin in spasmodic torticollis. 408 67

Scarring around the electrically stimulating electrodes has been of concern since dorsal column stimulation was introduced. This concern resurfaced in the days of cerebellar electrodes and, with the advent of epidural stimulating techniques for the control of pain and spasticity, it again arises as a potential problem. We present a patient who underwent the placement of a C-2-C-4 electrode to treat torticollis; 3 months later, a mild spastic quadriparesis developed and the stimulation became ineffective. At reexploration, dense scar surrounded the electrode and confined the cervical spinal cord. With microdissection techniques, the scar was removed from the dura mater and the dura began to pulsate freely. The quadriparesis reversed. Examination of the scar tissue microscopically showed linearly arrayed fibroblastic nuclei, and we are uncertain whether the exuberant fibroblastic response is a response to electrical stimulation, the materials used in the electrode, or some technical aspects of the operation.
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PMID:Scarring around cervical epidural stimulating electrode. 660 94

Cervical spine injuries in children are usually benign, severe traumatism being exceptional. The authors report 4 observations of severe traumatisms, 2 of which have required surgical treatment. Moreover they insist on the interest of acupuncture in the treatment of torticollis and of pain in the cervical spine after injury. The authors also point out the frequent aspect of anterior pseudo-subluxation C2-C3 which corresponds to a genuine medio-cervical physiological hinge.
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PMID:[Cervical spine injuries in children]. 661 24

The results of upper cervical anterior rhizotomy and accessory nerve section in the treatment of twenty patients with spasmodic torticollis are reviewed. The majority of these patients presented with pain in addition to postural deformity. There was no evidence in any of them to suggest that the condition was psychogenic. Good results can be expected, particularly in those patients without evidence of cervical spondylosis. We suggest that in symptomatic torticollis surgery is more effective than medical, psychiatric, or other described forms of treatment. Electromyography may be helpful to delineate the affected musculature and to assess postoperative improvement. The operating microscope is a valuable adjunct to surgery to preserve radicular vessels and ensure total division of the relevant motor roots.
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PMID:The surgical treatment of spasmodic torticollis. 693 Feb 32

Stimulation of the thalamus and internal capsule with Medtronic deep brain stimulation electrodes produced improvement in pain, hemiparesis, dystonia, torticollis, tremor. speech impairment and epilepsy. Stimulation at voltages above or below clinically effective levels (e.g., 6 V, 0.3 ms, 74 Hz) resulted in a loss of clinical efficacy. Somatosensory evoked responses (short and long latency) and depth electrode recordings were helpful in localisation and 'biocalibration' of electrical stimulation.
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PMID:Reversibility of chronic neurologic deficits. Some effects of electrical stimulation of the thalamus and internal capsule in man. 697 64

There is a growing body of evidence that the central nervous system (CNS), even in the adult animal, is capable of adaptation and reorganization not only as a result of partial damage to the CNS but also in response to stimulation. Environmental stimulation produces changes including expansion of visual cortex, increases in dendritic branching, glia and cholinesterase. Environmental stimulation also produces behavioural changes. Experimental electrical stimulation produces changes in synapse size, synaptic vesicle change, dendritic branching and changes in synaptic transmission. In man, repetitive electrical stimulation via epidural electrodes increases plasma levels of norepinephrine, epinephrine, and dopamine, and CSF levels of norepinephrine. Repetitive electrical stimulation in man dates back to 1967 and has been used for the control of pain, to improve spasticity, bladder control, motor deficit and the autonomic hyperreflexia of spinal cord injury. In addition, improvement has been reported in epilepsy, cerebral palsy, torticollis and peripheral vascular diseases. The best controlled studies are in multiple sclerosis and peripheral vascular disease, and these results will be presented in more detail.
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PMID:Rehabilitation following brain damage: some neurophysiological mechanisms. The effects of repetitive stimulation in recovery from damage to the central nervous system. 718 88


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