Benign paroxysmal torticollis

Benign paroxysmal torticollis (BPT) is a rare medical disorder affecting infants.[1]

Symptoms

The defining characteristic of BPT is a tilting of an infant's head in recurrent episodes, for varying periods of time.[1][2] Furthermore, the child's trunk may bend in the same direction as the head, giving the baby an overall curved shape; this complaint is known as tortipelvis.[1][2] In addition to this, the individual may also, but not necessarily, experience vomiting, pallor, ataxia, agitation, infantile migraine, unsteadiness of gait upon learning to walk, general malaise and nystagmus.[1][2]

The periods in which the child's head is tilted and other symptoms appear can last anywhere from a few minutes to a few weeks, with a frequency of anywhere from two per year to two per month.[1][2]

Causes

The cause of benign paroxysmal torticollis in infants is thought to be migrainous. More than 50% of infants have a family history of migraine in first degree relatives. The cause is likely to be genetic.[1][2]

Pathophysiology

The mechanism of action of benign paroxysmal torticollis is not yet understood.[1][2][3] It has been suggested that unilateral vestibular dysfunction[3] or vascular disturbance in the brain stem[1] may be responsible for the condition.

Diagnosis

Diagnosis of BPT can be difficult because it is rare.[3]

Treatment

No known treatment for BPT currently exists.[1] However, the condition it is self-limiting and resolves after about eighteen months.

Prognosis

Benign paroxysmal torticollis disappears in the early years of life with no medical intervention.[1][2][3]

However, some cases of benign paroxysmal torticollis cases can evolve into benign paroxysmal vertigo of childhood, migrainous vertigo or typical migraines.[1][2]

History

The condition was first described by CH Snyder in 1969 in an article titled “Paroxysmal torticollis in infancy. A possible form of labyrinthitis.” in the American Journal of Diseases of Children.[1][2][3]

References
  1. Deonna, T. & Martin, D. (1981) Benign paroxysmal torticollis in infancy. Archives of Disease in Childhood. 56:956-959.
  2. Drigo, P. Carli, G. & Laverda, A.M. (2000) Benign paroxysmal torticollis of infancy. Brain and Development. 22:169-172.
  3. Eviatar, L. (1994) Benign Paroxysmal Torticollis. Pediatric Neurology. 11:72.
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