François Rabelais and his dystonic giants.

Spasmodic torticollis was an early designation used for cervical dystonia. The origin of this name is attributed to French physician and writer François Rabelais in the mid-sixteenth century. This early description of torticollis in the book Pantagruel was an inspiration for the understanding of cervical dystonia. The art expressed in Rabelais' literature ‒ which was immortalized by the drawings of Gustave Doré ‒ influenced poetry, art, and photography, and led to the adoption of the term torticollis in the neurological sciences.

Uma designação inicial usada para distonia cervical era torcicolo espasmódico. A origem desse termo é atribuída ao médico e escritor francês François Rabelais em meados do século XVI. Essa descrição inicial do torcicolo no livro Pantagruel foi uma inspiração para a compreensão da distonia cervical. A arte exibida na literatura de Rabelais ‒ imortalizada pelos desenhos de Gustave Doré ‒ influenciou a poesia, a arte e a fotografia, e levou à adoção do termo torcicolo nas ciências neurológicas.

Physiology of midbrain head movement neurons in cervical dystonia.

BACKGROUND: Early theories for cervical dystonia, as promoted by Hassler, emphasized the role of the midbrain interstitial nucleus of Cajal. Focus then shifted to the basal ganglia, and it was further supported with the success of deep brain stimulation. Contemporary theories suggested the role of the cerebellum, but even more recent hypotheses renewed interest in the midbrain. Although the pretectum was visited on several occasions, we still do not know about the physiology of midbrain neurons in cervical dystonia. METHODS: We analyzed the unique database of pretectal neurons collected in the 1970s and 1980s during historic stereotactic surgeries aimed to treat cervical dystonia. This database is valuable because such recordings could otherwise never be obtained from humans. RESULTS: We found the following 3 types of eye or neck movement sensitivity: eye-only neurons responded to pure vertical eye movements, neck-only neurons were sensitive to pure neck movements, and the combined eye-neck neurons responded to eye and neck movements. There were the 2 neuronal subtypes: burst-tonic and tonic. The eye-neck or eye-only neurons sustained their activity during eccentric gaze holding. In contrast, the response of neck-only and eye-neck neurons exponentially decayed during neck movements. CONCLUSIONS: Modern quantitative analysis of a historic database of midbrain single units from patients with cervical dystonia might support novel hypotheses for normal and abnormal head movements. This data, collected almost 4 decades ago, must be carefully viewed, especially because it was acquired using a less sophisticated technology available at that time and the aim was not to address specific hypothesis, but to make an accurate lesion providing optimal relief from dystonia. © 2017 International Parkinson and Movement Disorder Society.

History of the 'geste antagoniste' sign in cervical dystonia.

The geste antagoniste is a voluntary maneuver that temporarily reduces the severity of dystonic posture or movements. It is a classical feature of focal and particularly cervical dystonia. However, the precise historical aspects of geste antagoniste still remain obscure. The goals of this review were (1) to clarify the origin of the geste antagoniste sign; (2) to identify the factors that led to its diffusion in the international literature; (3) to follow the evolution of that term across the twentieth century. We used medical and neurological French, German and English literature of the late nineteenth and early twentieth centuries, and the PubMed database by entering the terms geste antagoniste, antagonistic gesture and sensory trick. The geste antagoniste sign is a legacy of the Paris Neurological School of the end of the nineteenth century. The term was introduced by Meige and Feindel in their 1902 book on tics, written in the vein of their master, Brissaud, who first described this sign in 1893. The almost immediate translations of this book by Giese into German and Kinnier Wilson into English contributed to the rapid spreading of the term geste antagoniste, which is still in use worldwide today. The term antagonistic gesture is the translation proposed by Kinnier Wilson, which also led to the use of the term geste antagonistique. The geste antagoniste sign has long been considered a solid argument for the psychogenic origins of dystonia until the 1980s when Marsden made strong arguments for its organic nature.

Surgery for cervical dystonia: the emergence of denervation and myotomy techniques and the contributions of early surgeons at The Johns Hopkins Hospital.

Cervical dystonia is a psychologically and physically disabling disease that has intrigued clinicians since the early history of surgery. Because of its elusive etiology, its operative treatment has had an extended evolutionary voyage. Early surgical approaches involved resection of the sternocleidomastoid muscle. Later recognition of more diffuse involvement of the posterior neck muscles led to the introduction of new techniques with more effective results. A review of available surgical patient records at The Johns Hopkins Hospital from around the turn of the 20th century provided a glimpse of the early history of the operative treatment for torticollis through the work of some of the leaders of surgery, including Halsted, Cushing, and specifically Finney. Here, the authors present a segment of history on the surgical treatment of this disease as it relates to the introduction of myotomy and denervation techniques.

Descriptions of cervical dystonia by Sir Charles Bell.

Sir Charles Bell is better known among neurologists for his descriptions of the clinical consequences of facial nerve lesions. However, as an accomplished physician, anatomist, and artist, he made many other contributions to the fields of neurology and neuroscience. Among those, his descriptions of patients with what we now know as cervical dystonia have not received much attention. In this report, Bell's depictions of patients presenting with a syndrome consistent with cervical dystonia will be discussed, including the identification of many of the different clinical features we currently use for the diagnosis of this disorder and his thoughts about its pathogenesis.

Surgery of involuntary movements, particularly stereotactic surgery: reminiscences.

WHEN WE STARTED using stereotactic surgery in 1953, the existing stereotactic instruments required general anesthesia for fixation of the head. We designed a stereotactic instrument with target screens that could be fixed to the patient's head under local anesthesia. The results of stereotactic surgery for spasmodic torticollis were inconsistent. The active muscles were identified by electromyography and blocked with 1% lidocaine, resulting in marked but temporary improvement. It was decided to use selective peripheral denervation in these cases with very satisfactory results, and it became the only procedure we used for the relief of spasmodic torticollis.

[Multiple pathology in a Merowingian individual of a graveyard near Insheim (Rhineland-Pfalz)]. / Multiple Pathologien an einem merowingischen Individuum aus einem Reihengräberfeld bei Insheim (Rheinland-Pfalz).

The following case report describes in detail a 57 years old (+/- 5 years) male individual from a Franconian graveyard in Insheim, Province of Rhineland-Palatinate, dating to between the 6th and 7th century A.D. The individual displays a number of unusual pathologies. The atlas shows a complete aplasia of the posterior arch, probably resulting in a torticollis. The changed static induced a massive spondylar-arthrotic degeneration of the cervical spine on the right-lateral portion. On the fronto-parietal section two fractures are visible which were caused by a sharp and violent force. The area in question measures 7 by 10 cm. It has healed in a dislocated position. The second location displays marks of a 6 cm long sword-cut which did strike the skull obtusely on the left parietal. In addition to the above the skull displays on its right side a great number of small circular hole defects which also appear on ribs, vertebrae, clavicula and the mandible. They present the typical picture of a plasmocytoma. As an expression of a secondary hyperparathyreoidism one can recognize ossifications of soft tissue on the calcaneus, tibia, fibula and patella as well as intravital loss of mandibular dentition. It is quite remarkable that the individual reached a relative old age despite of his numerous and serious physical encroachments due to the apparent and obvious intentions of his aggressive contemporaries to kill him.

Wryneck in the ancient Hawaiians.

A unique cranial asymmetry previously noted in the skeletal remains from Mokapu, O'ahu, Hawai'i, is described. The anomaly involves an indentation of one or both of the occipital condyles and facial and vault asymmetry. This examination of the asymmetry includes a search for other reported occurrences, a detailed description, and a differential diagnosis. A multiple working hypothesis approach is employed. Comparison of the osseous material with the expected clinical pictures in craniosynostosis, Kleippel-Feil syndrome, primary basilar impression, and torticollis results in the most likely explanation of congenital torticollis. A high rate of occurrence of the anomaly (1.8%) is found in the skeletal remains from the Hawaiian Islands, but it has been documented in only two instances outside Hawai'i. A survey of patients seen at The Shriner's Hospital for Crippled Children does not reveal a high rate of occurrence of torticollis in Hawaiians relative to other ethnic groups.

Kenneth McKenzie, Harvey Cushing, and the early neurosurgical treatment of spasmodic torticollis.

In 1923, Dr. Kenneth McKenzie trained at the Peter Bent Brigham Hospital under Dr. Harvey Cushing. At that time, a patient with spasmodic torticollis came to Cushing and was treated with an innovative operation for this disorder with good results. This case sparked an interest in Dr. McKenzie, who published the case 1 year later. In reviewing the surgical histories from the Peter Bent Brigham Hospital, we have found the original records of this well-documented case. The record includes postoperative drawings of the intraoperative field by Dr. Cushing, a sketch by Dr. McKenzie illustrating the postoperative sensory examination, and pre- and postoperative photographs of the patient.

[The history of psychotherapy of torticollis. A historical review]. / Zur Geschichte der Psychotherapie des Torticollis. Eine historische Ubersicht.

Beginning with a historical introduction the author gives an overview over the different forms of psychotherapy used for torticollis. A special reference is given to psychoanalytic concepts. The different etiological concepts of this disease imply corresponding heterogeneous forms of therapy.