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Introduction: There exists a wide differential of etiologies for pediatric torticollis that extend beyond musculoskeletal factors. Case Report: We present a novel case of an 8-year-old male with acute, atraumatic hemorrhage of the left cerebellum presenting with gradual worsening torticollis. Upon further diagnostic workup, he was found to have an intracerebral hemorrhage due to a cerebellar cavernous malformation. Though the hemorrhage boundaries were extensive, the patient had only exhibited transient dysmetria and facial weakness, with ultimate resolution of torticollis and these neurological symptoms after several days. Conclusion: This case demonstrates the importance of maintaining a broad differential in the workup of acute pediatric torticollis.

Congenital muscular torticollis is a postural disorder which usually manifests within the first four weeks following the child’s birth. It is characterised by leaning the head to the affected side and rotating the head to the opposite side, and it is a consequence of unilateral shortening and fibrosis of the sternocleidomastoid muscle. The aim of this paper is to review current professional and scientific literature which deals with the methods of physiotherapy evaluation and interventions in children with congenital muscular torticollis, and to propose the most efficient physiotherapy interventions based on the results of such review. All publications reviewed in this paper favour conservative treatment of congenital muscular torticollis, which includes passive stretching of the sternocleidomastoid muscle, advising parents on proper positioning of the child and use of helmet in case of pronounced plagiocephaly. According to current research, manual massage techniques, which may form part of physiotherapy interventions, do not contribute to improved treatment outcomes, since treatment outcomes are the same in children who were subjected only to stretching exercises and those who additionally received manual massage. The duration of physiotherapy and frequency of sessions depend on numerous factors – mainly on the severity of torticollis and the child’s age at the time when physiotherapy started. [ABSTRACT FROM AUTHOR]

Background: Recurrent cases of spontaneous spinal epidural hematoma are rare, and there are no reports of spontaneous resolution and recurrence in toddlers. Case presentation: We present a case of a toddler with a cervical spontaneous spinal epidural hematoma, characterized by three episodes of sudden-onset transient torticollis with subsequent natural recovery. The patient was referred to our hospital after the second episode, during which symptoms were already improving. Conservative management without surgery was chosen, leading to spontaneous resolution. During the third episode, the symptoms were mild, and observation was again selected, resulting in natural improvement. Post-resolution magnetic resonance imaging revealed an extradural cyst, suggesting that the hemorrhage had occurred within the cyst. Conclusion: Recurrent cases of cervical spontaneous epidural hematomas often resolve with conservative treatment, particularly in cases with mild myelopathy. Our case suggests a possible association between a spinal cystic structure and hemorrhage within the spinal canal. Conservative management may be appropriate in cases of spontaneous epidural hematomas with mild or improving symptoms to avoid the risk of postoperative kyphosis. [ABSTRACT FROM AUTHOR]

Fibromatosis colli of infancy, a benign spindle cell lesion originating from sternocleidomastoid muscle, can be diagnosed under appropriate clinical settings, aided by radiological and cytological findings. If diagnosed early, unnecessary surgical interventions could be avoided. [ABSTRACT FROM AUTHOR]

Atlanto-axial rotary subluxation (AARS) is rare but recognized as a significant cervical spine injury following a fall or physical impact on the head or neck in children aged 5–15 years. Trampoline use has been increasing among children, as have the trampoline-related injuries (TRI). We present a case series of AARS following trampoline injuries, highlighting clinical presentation, diagnosis, and management, especially in an emergency setting. We report four children with an average age of 8.5 years (range 6–12 years) presented to our hospital emergency service with neck pain and torticollis following a TRI. The diagnosis was confirmed through X-ray and computed tomography imaging, revealing Fielding and Hawkins type 1 AARS. Conservative treatment with analgesics, muscle relaxants, and a cervical collar led to recovery in three cases, while one required halter cervical traction for persistent deformity. All patients recovered completely, with no long-term complications. AARS in children is largely a type 1 injury with a favorable prognosis. Early recognition and management are crucial in preventing complications. The increasing incidence of neck injuries caused by trampoline use in children necessitates strict safety regulations regarding its use.

Objectives: This review aims to analyze the treatment options for peritonsillar abscess (PTA) in children. Methods: We searched PubMed and EMBASE for studies regarding the treatment of PTA in children. Relevant studies were reviewed based on systematic review (PRISMA) guidelines. Qualitative and quantitative analyses of the extracted data were performed. Results: A total of 12 articles with 2211 cases of PTA were found to be eligible. All the identified studies were retrospective cohorts. The mean age varied from 8.5 to 15.4 years without gender difference. Treatment options included broad-spectrum antibiotic therapy with incision and drainage of the abscess, needle aspiration and immediate tonsillectomy in 69%, 7.6% and 7% of cases, respectively. Antibiotics alone were administered to 16.4% of the subjects. The rate of recurrence of PTA after primary treatment ranged from 2% to 15.8% of cases. The time of recurrence is considered within one or two months. Complications in children with PTA were torticollis, prolonged fever, sepsis, dyspnea and parapharyngeal involvement. Conclusions: The mainstay of treatment of PTA in children is antibiotic therapy with incision and drainage of the abscess. Alternatives include antibiotic treatment alone or in association with needle aspiration. Immediate tonsillectomy is reserved only for a few high-risk patients. [ABSTRACT FROM AUTHOR]

Background: Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) is widely employed for cervical dystonia (CD) evaluation. Objective: To assess the inter‐rater reliability of the severity subscale of the original and revised TWSTRS using video recordings. Methods: Three raters, a PhD student with a nursing degree, a physiotherapist specialized in CD, and a neurologist‐in‐training independently rated all videos. The inter‐rater reliability was assessed with the intra‐class correlation coefficient (ICC). Results: The total severity score of both tools demonstrated a good inter‐rater reliability (ICC = 0.87 to 0.88). The inter‐rater reliability of individual sub‐items varied from poor (ICC = 0.29) to excellent (ICC = 0.9). Conclusions: The total severity score of both TWSTRS showed good inter‐rater reliability in a multidisciplinary team, indicating their applicability for online patients' assessment. We recommend using the total subscale for outcome comparison. Furthermore, there is a need for more accurate definitions of duration factor and shoulder elevation. [ABSTRACT FROM AUTHOR]

A small proportion of children with a sudden onset torticollis ("wry neck") presents with an atlantoaxial rotatory subluxation, usually after mild trauma or recent head or neck infection. Torticollis is a clinical diagnosis and imaging is usually not indicated, though often performed in clinical practice. Atlantoaxial rotatory subluxation on imaging is often a physiological phenomenon in torticollis, and concomitant neurological symptoms are therefore rare. Treatment is primarily conservative, with analgesics, a rigid neck collar, and if needed benzodiazepines to counteract muscle spasms and anxiety. In case of treatment failure or chronic subluxation, cervical repositioning and fixation under general anesthesia may be considered. Surgical treatment is only indicated in a small percentage of patients with chronic refractory subluxation, concomitant cervical fractures, or congenital anomalies. Early diagnosis and treatment are important, since this is associated with a more successful conservative outcome than a prolonged approach. [ABSTRACT FROM AUTHOR]

An abnormal head position (AHP) refers to a condition where the head is deviated from the usual, upright posture considered normal. AHPs can manifest as the chin being raised or lowered, the head tilted to the right or left, the face turned to either side, or a combination of these movements. Patients with AHP may present to ophthalmologic clinics; however, there are several etiologies for AHP that may not be commonly recognized by ophthalmologists. Key words from this article were searched in PubMed, Scopus, and Google Scholar search engines from 1975 to December 2023. Various etiologies were identified, evaluated, summarized, and then categorized. The maintenance of a normal head posture during our daily activities relies on the complex interaction of different parts of the brain, with the encoding of related sensory inputs occurring in the vestibular nuclei. Abnormal head posture can stem from a variety of etiologies, including ocular, neurological, orthopedic, otolaryngological, gastroenterological, and other factors. This review provides a comprehensive overview of the different characteristics of AHP based on its etiology. Lack of awareness regarding the wide spectrum of causes may lead to patients undergoing unnecessary extensive workups. Conversely, failure to recognize potentially life-threatening causes may result in adverse outcomes for the patient. [ABSTRACT FROM AUTHOR]

Dopamine receptor antagonists like metoclopramide are frequently used in a variety of clinical contexts to treat gastrointestinal disorders and control nausea and vomiting. However, it is associated with a high incidence of extrapyramidal side effects (EPS) in children, including dystonic movements and torticollis. This is the instance of a 9-year-old girl who developed abnormal movements of the neck and tongue, along with torticollis, within 48 hours of receiving intravenous metoclopramide for gastroenteritis. The metoclopramide therapy was discontinued, and supportive measures, including diphenhydramine, were initiated, resulting in the resolution of symptoms. This case highlights the importance of recognizing and managing metoclopramide-induced EPS in pediatric patients. [ABSTRACT FROM AUTHOR]

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Torticollis is defined as an imbalance of the sternocleidomastoid muscle (SCM), with less extension of the neck, resulting in a preference to turn the head more from one side to the other. The characteristics frequently found are: ear contralateral to the torticollis displaced forward, facial asymmetry, and contralateral occipital flattening, as well as a smaller ipsilateral eye, causing misalignment of the eyes. This condition can also cause mandibular inclination (MI), in the frontal plane, with a difference in opening between the maxilla and mandible from one side or the other. The diagnosis and treatment of torticollis are routinely carried out by the physiotherapist and the diagnosis of this mandibular inclination is traditionally through visual examination. This assessment of mandibular inclination, carried out by the dentist, in an objective manner, can contribute to the diagnosis and also to the monitoring of proposed treatments that should reduce mandibular asymmetries. The objective of this study was to create a protocol for objective measurement of the distance between the maxilla and mandible, on the right and left sides, using photogrammetry, to detect whether mandibular inclination can be observed by the shorter inter-arch distance on the side corresponding to the torticollis. Case reports of two babies (1 baby aged 9 months and another aged 1 year and 1 month), diagnosed with congenital torticollis. Photogrammetry was carried out: the babies were positioned on a dental stretcher and photographed in maximum opening, intermediate, and closing positions. Using the photos and the IMAGE J program, measurements between the maxilla and mandible were taken (see photogrammetry description). Results: The measurement protocol used in both babies confirmed the greater mandibular inclination by approaching the hemi-arch corresponding to the side of the torticollis, compared to the opposite side. Objective measurement of mandibular inclination can be part of the timely diagnosis for congenital torticollis. Studies with an adequate sample size and methodology are necessary to confirm this diagnostic tool. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the influence of surgical therapy, intraoperative evaluation, and immediate physiotherapy on the facial asymmetry of patients with congenital muscular torticollis (CMT). Patients who underwent a combination of unipolar sternocleidomastoid muscle release with perioperative physiotherapy between 2014 and 2020 in the Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen were enrolled. Three-dimensional photographs of the face acquired 2 months preoperatively and 1.5–2 years postoperatively were assessed. Based on 43 patients, there was a significant improvement in the asymmetry indices (angles between bilateral exocanthion, bilateral cheilion, and nasion–gnathion lines): mean ± standard deviation reductions in indices (Ex–Ex)–(Ch–Ch), (Ex–Ex)–(Na–Gn), and (Ch–Ch)–(Na–Gn) of 0.88 ± 1.08° (P < 0.001), 1.04 ± 1.26° (P < 0.001), and 0.21 ± 1.06° (P = 0.024), respectively. Analysis of covariance (ANCOVA) showed that intervention at an early age (P = 0.017) and left-sided torticollis (P = 0.030) were associated with a significantly greater improvement in the facial asymmetry. This study found that the use of combined surgery and physiotherapy reduced the facial asymmetry of patients with CMT at 2 years postoperatively. Early intervention and left-sided torticollis were associated with a greater improvement in the facial asymmetry. This indicates that attention should be given to early intervention and right-sided CMT cases postoperatively. [ABSTRACT FROM AUTHOR]

The relevance of the problem is determined by the rather high prevalence of central nervous system (CNS) tumors in children and the need for oncologic vigilance. The presentation of the clinical case illustrates the need for careful analysis of the initial clinical signs, which are usually nonspecific and may resemble symptoms of other diseases. A case from practice describes the timely diagnosis of pilocytic astrocytoma in a child of the first year of life with torticollis as the debut of the disease. The diagnosis was made on the basis of a thorough clinical, neurological, and immunohistochemical examination and the use of neuroimaging techniques with the goal of further surgical, medical, and radiation treatment. The aim of the work. Description of a clinical case of astrocytoma of the cervical spinal cord, which manifested itself as torticollis in a child in the first year of life. Material and methods of the research. Clinical, biochemical, immunohistochemical, and imaging examination of a child of toddler age. Results of the research. A child with manifestations of torticollis at the age of eleven months was studied. Variants of congenital and acquired torticollis and inflammatory diseases of the central nervous system were excluded. According to clinical, neurological, and neuroimaging examinations, the diagnosis was made: benign intramedullary neoplasm of the spinal cord, pilocytic astrocytoma C5-Th2. Surgical intervention was performed with partial removal of the tumor with histochemical examination, followed by restorative therapy and observation in the distant postoperative period. Conclusions. Sudden appearance of symptoms of torticollis in a child in the first year of life may indicate the presence of a CM tumor. Early diagnosis allows to provide the child with highly specialized care, perform surgical intervention, and contribute to the improvement of the general condition and quality of life. [ABSTRACT FROM AUTHOR]

Introduction: Cranial remolding orthoses (CROs) are used to treat deformational plagiocephaly. Treatment outcomes vary widely depending on treatment timing and severity of the deformity. The relative impact of these factors on success rates is not well known. Objective: This study aimed to quantify success rates of CRO treatment, based on age at initiation of treatment and the severity of cranial deformity. Study Design: This is a retrospective cohort study of infants treated for positional plagiocephaly with a CRO. Methods: A total of 300 infants with deformational plagiocephaly who were treated with a CRO were categorized into four groups by corrected age at initiation of orthotic treatment (<22 weeks, 22–25 weeks, 26–30 weeks, and >30 weeks) and into four groups by severity of their deformity (initial cranial vault asymmetry of 6–9 mm, 10–12 mm, 13–16 mm, and 17+ mm). Success rates were compared across the groups. A successful outcome was defined as achieving a final cranial vault asymmetry of 5 mm or less. Results: The overall success rate for CRO treatment was 75%. However, success rates among the groups varied from 6% to 98%, depending on the severity and the age at initiation. Severity had a more significant effect on success rates than age at initiation. The age at initiation became more influential in determining the likelihood of success when the infant's deformity was severe. Conclusions: The likelihood of achieving a successful treatment outcome with a CRO varies greatly depending on the severity of the deformity and corrected age at initiation of treatment, with severity having the greater impact. Clinical Relevance: This study provides clinicians with treatment outcomes categorized by severity and corrected age at initiation to aid in setting appropriate expectations for treatment outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Cervical hemivertebrae (C3-6) causing significant osseous torticollis, head tilt and facial asymmetry are rare and complicated. Cervical hemivertebrectomy (CHVE) by a posterior-only approach was never reported because it is highly risky and its efficacy remains controversial. This study is to evaluate the feasibility and preliminary clinical outcomes of posterior-only approach for CHVE and torticollis correction in young children. Methods: Four young children aged 5–9 years old with significant torticollis caused by cervical hemivertebrae underwent deformity correction consisting of cervical pedicle screw (CPS) placement with O-arm-based intraoperative navigation, CHVE using ultrasonic bone scalpel and short-segmental posterior instrumentation and fusion. Details of this novel technique were presented. The preliminary short-term clinical and radiographic outcomes were assessed. Results: On average, the operative time was 312.5 ± 49.9 min, and the surgical blood loss was 375.0 ± 150.0 ml. The structural cervical scoliosis was corrected from 31.5 ± 7.3° to 11.0 ± 4.1°, and the average correction rate was 64.9%. Head tilt was favorably corrected from 11.0 ± 4.2° to 3.5 ± 2.6°. The shoulder balance improved from 6.3 ± 1.3° to 1.5 ± 1.9°. One case with C6 CHVE had convex side radiating nerve root pain but no sign of muscle power weakness. Full recovery was achieved one month after surgery. No other complication occurred. Conclusions: CHVE by a posterior-only approach was a feasible alternative option for the treatment of congenital cervical scoliosis. It could resect the CHV effectively and achieve satisfactory torticollis correction without additional anterior access surgery. Successful CPS placement in this child population was essentially important to enable reliable osteotomy closure and firm posterior instrumentation. [ABSTRACT FROM AUTHOR]

Atlanto-axial rotary subluxation (AARS) is rare but recognized as a significant cervical spine injury following a fall or physical impact on the head or neck in children aged 5–15 years. Trampoline use has been increasing among children, as have the trampoline-related injuries (TRI). We present a case series of AARS following trampoline injuries, highlighting clinical presentation, diagnosis, and management, especially in an emergency setting. We report four children with an average age of 8.5 years (range 6–12 years) presented to our hospital emergency service with neck pain and torticollis following a TRI. The diagnosis was confirmed through X-ray and computed tomography imaging, revealing Fielding and Hawkins type 1 AARS. Conservative treatment with analgesics, muscle relaxants, and a cervical collar led to recovery in three cases, while one required halter cervical traction for persistent deformity. All patients recovered completely, with no long-term complications. AARS in children is largely a type 1 injury with a favorable prognosis. Early recognition and management are crucial in preventing complications. The increasing incidence of neck injuries caused by trampoline use in children necessitates strict safety regulations regarding its use. [ABSTRACT FROM AUTHOR]

Background: Postural asymmetry (PA) may occur in infancy and is a diagnosis with a wide range of signs. Material and methods: The motor development of fifty PA children aged 0–18 months was investigated based on the use of the Alberta Infant Motor Scale (AIMS). Additional assessment was made to determine the head shape and sternocleidomastoid muscle (SCM) tone. The children underwent physiotherapy using neurodevelopmental-based improvement methods. Conlusions: This study aimed to examine the relationship between PA and motor development in children and between the effects of therapy and the time of initiation and duration of rehabilitation. Postural asymmetry affects the course of a child’s motor development. Therefore, early detection of developmental delays in a child is important, especially in terms of enabling early intervention and undertaking therapeutic measures. [ABSTRACT FROM AUTHOR]

Pigeon paramyxovirus type 1 (PPMV-1) is a serious pathogen facing the pigeon industry. Thus, this study aimed to preparation and evaluation of two inactivated vaccines using Carbopol and Aluminum hydroxide-based adjuvants to control such a problem. A total of 45-four weeks old, apparently healthy pigeons were allocated into 3 groups (15 birds each) as follow: group 1 (G1) received 0.5 ml, S/C Carbopol adjuvanted vaccine, group 2 (G2), received 0.5 ml S/C of aluminum hydroxide-based vaccine, group 3 (G3) received 0.5 ml S/C sterile saline and kept as control group. Five serum samples were obtained from each bird weekly post vaccination to measure anti-PPMV-1 antibodies using HI test. At 35 days post immunization, all vaccinated pigeons were challenged with 20µl containing 106 EID50/bird of PPMV-1 YA/14 strain by eye drop route, all pigeons were kept under observation for 10 days during the observation period any clinical signs or moralities were recorded also, cloacal swabs were collected 4-, 7- and 10-days post challenge to measure the shedding level. The potency test revealed that the prepared inactivated vaccine (PPMV-1) with synthetic polymeric adjuvants were potent and efficient. By studying the elicited serum antibody dynamics in vaccinated pigeon using HI test showed that antibody, the beak antibody titer reached by the 4th week post immunization (6 and 5 log 2) for both G1 and G2 respectively (but G1 is significantly increase than G2) and continued to the 5th week where it reaches 6.5 and 5.6 log2 for both groups in order. (G1 is significantly increase than G2), which indicated that the PPMV-1 inactivated vaccine in both G1 and G2, results in systemic adjuvant activity, including a long-lasting protective immune response after a single dose administration without any adverse reaction. G1 and G2 showed the lowest shedding level that was zero at the 10th day post challenge and the overall reduction level of both vaccinated groups was 4.9 and 4.5 for both G1 and G2, respectively. However, the prepared inactivated PPMV-1 Carbopol based vaccine is safe and could significantly poses the immune response more effectively than the aluminum hydroxide-based vaccine. [ABSTRACT FROM AUTHOR]

We identified a de novo heterozygous transient receptor potential cation channel subfamily M (melastatin) member 3 (TRPM3) missense variant, p.(Asn1126Asp), in a patient with developmental delay and manifestations of cerebral palsy (CP) using phenotype-driven prioritization analysis of whole-genome sequencing data with Exomiser. The variant is localized in the functionally important ion transport domain of the TRPM3 protein and predicted to impact the protein structure. Our report adds TRPM3 to the list of Mendelian disease-associated genes that can be associated with CP and provides further evidence for the pathogenicity of the variant p.(Asn1126Asp).

Background: Myofascial trigger points (TrPs) are hypersensitive points located in a tight band of muscle that, when palpated, produce not only local pain but also referred (distant) pain. The role of TrPs in patients with cervical dystonia (CD) has not been investigated. Objective: To identify the presence of TrPs in patients with isolated idiopathic CD and their association with pain. Methods: Thirty‐one patients (74.2% women; age: 61.2 years, SD: 10.1 years) participated. TrPs were explored in the sternocleidomastoid, upper trapezius, splenius capitis, levator scapulae, anterior scalene, suboccipital, and infraspinatus muscles. Clinical features of CD were documented as well as the presence of pain. The severity of dystonia and its consequences were assessed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Results: The mean number of TrPs for each patient was 12 (SD:3), with no differences between patients with pain (n = 20) and those without pain (n = 11). Active TrPs were only found in patients with pain (mean: 7.5, SD:4). Latent TrPs were found in both groups but were more prevalent (P < 0.001) in patients without pain (mean: 11, SD:3.5) than in those with pain (mean: 5, SD:3.5). The number of active TrPs or latent TrPs was positively associated with the TWSTRS disability subscale and the TWSTRS total score. The number of active, but not latent, TrPs was associated with worse scores on the TWSTRS pain subscale. Conclusion: Active TrPs were present in patients with CD reporting pain, while latent TrPs were present in all CD patients, irrespective of their pain status. The numbers of active/latent TrPs were associated with disability. TrPs could act as pain generators in CD and also contribute to the involuntary muscle contractions characteristic of dystonia. [ABSTRACT FROM AUTHOR]

Background Purpose Cyclic vomiting syndrome (CVS) is identified as one of the “episodic syndromes that may be associated with migraine,” along with benign paroxysmal torticollis, benign paroxysmal vertigo, and abdominal migraine. It has been proposed that CVS and migraine may share pathophysiologic mechanisms of hypothalamic activation and altered dopaminergic signaling, and impaired sensorimotor intrinsic connectivity. The past decade has brought groundbreaking advances in the treatment of migraine and other headache disorders. While many of these therapies have yet to be studied in episodic syndromes associated with migraine including CVS and abdominal migraine, the potential shared pathophysiology among these conditions suggests that use of migraine‐specific treatments may have a beneficial role even in those for whom headache is not the primary symptom.This manuscript highlights newer therapies in migraine. Calcitonin gene‐related peptide (CGRP) and its relation to migraine pathophysiology and the therapies that target the CGRP pathway, as well as a 5HT1F receptor agonist and neuromodulation devices used to treat migraine are briefly discussed as they may potentially prove to be useful in the future treatment of CVS. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the clinical efficacy of minimally invasive endoscopic treatment of children with congenital muscular torticollis (CMT). Methods: In total, 72 children (41 male, 31 female) with CMT who underwent endoscopic surgery at the Department of Orthopedics, Xi'an Children's Hospital, between January 2021 and January 2023 were included. Their mean age was 54 ± 36.1 (range, 12–141) months. Of these, 29 (40.3%) cases involved the left side while 43 (59.7%) involved the right side. Preoperative preparation involved precise body surface markings of the sternocleidomastoid muscle(SCM), clavicle, and important nerve and blood vessels, followed by the establishment of surgical channels through passive separation techniques. An arthroscope and a low-temperature plasma knife were utilized for accurate localization and surgical release of the clavicular and sternal heads of the SCM. The duration of surgery, blood loss, postoperative hospital stay, neck range of motion measurements, and any intraoperative or postoperative complications were analyzed using the rank sum test. Cervical and thoracic braces were applied for three months postoperatively, with follow-up assessments conducted using Cheng's scoring system. Results: All patients successfully underwent endoscopic surgery, without the need for conversion to open surgery. No intra- or postoperative complications were observed. The average surgical duration was 56.4 ± 15.7 min, with minimal intraoperative bleeding (1–5 mL) and no need for blood transfusion. The mean postoperative hospital stay was 2.7 ± 0.8 days. Over a mean follow-up period of 22.2 ± 5.5 (range, 14–32) months, significant improvements were observed in neck rotation (from 20.2° [17.7° to 25°] to only 3.6° [2° to 6.7°]) and lateral flexion (from 19° [17° to 22.6°] to only 3° [2° to 7.8°]) restrictions (p < 0.05). According to Cheng's scoring system, 70 (97.2%) patients achieved excellent or good clinical outcomes, while 2 (2.8%) had average outcomes. The torticollis deformity was corrected during the follow-up period, and all surgical incisions healed without noticeable scarring. Conclusion: Endoscopic release is a safe, effective, and minimally invasive treatment option for CMT in children. [ABSTRACT FROM AUTHOR]

Cervical dystonia (CD) is a movement disorder which causes sustained muscle contractions in the neck leading to abnormal postures and repetitive movements. As it is a highly visible condition, people with CD can experience stigma, which may lead to unhelpful coping strategies and increased psychological distress. This study investigated whether adaptive and maladaptive coping strategies mediate the relationship between stigma and psychological outcomes in people with CD. A total of 114 adults with CD completed measures of stigma, coping, health-related quality of life (HRQOL), psychological distress (depression, anxiety, stress), and psychological wellbeing at one time point. Participants' levels of distress were high, compared to the general population. Correlational analyses showed increased stigma and maladaptive coping (e.g. substance use, behavioural disengagement) were both significantly related to increased distress, lower wellbeing and lower HRQOL, whereas higher adaptive coping (e.g. acceptance, humour) was only related to higher wellbeing. In a parallel mediation model, maladaptive coping strategies mediated the relationship between stigma and distress, HRQOL and wellbeing, but adaptive coping strategies did not. These findings suggest that maladaptive coping may play an important role in explaining the relationship between stigma and some aspects of distress and wellbeing in CD. Interventions which focus on reducing different aspects of maladaptive coping may be helpful to improve wellbeing as well as reducing stigma. [ABSTRACT FROM AUTHOR]

Background/Objectives: The aim of this study was to investigate the effect of a custom neck collar with negative sensory feedback for the treatment of torticollis that was previously unresponsive to conservative or surgical treatment. Methods: Twenty-four children diagnosed with unresponsive or intractable torticollis were enrolled in this two-stage, single-arm study. The ipsilateral aspect of the orthosis is adjustable in height and designed to provide support between the clavicle and the mandibular angle on the tilted side. In stage 1 (the adjustment period), the orthosis with a smooth surface was applied for 2 h per day for 3 months. In stage 2, a rough surface with a hook-and-loop fastener (Velcro©) was attached to the collar, and it was worn for a further 2 h a day for 3 months. Twenty children (mean age 63.95 ± 13.44 months) were included in the analysis. Results: The mean torticollis angle was 17.60 ± 5.65° (mean ± SD) at baseline; 14.15 ± 3.62° directly after stage 1; and 6.00 ± 3.67° directly after stage 2 (X2 = 36.685, df = 19, p = 0.000). Conclusions: This study demonstrated the feasibility, therapeutic effect, and safety of a novel tactile feedback orthosis for the treatment of children with torticollis. The use of a custom neck collar with negative sensory feedback may be a viable therapeutic option for the treatment of unresolved or intractable torticollis. [ABSTRACT FROM AUTHOR]

Background: Transcranial Magnetic Stimulation (TMS) studies examining exercise‐induced neuroplasticity in pain populations have produced contradictory findings. We conducted a systematic review to explore how exercise impacts cortical excitability in pain populations using TMS metrics. This review aims to summarize the effect sizes and to understand their sources of heterogeneity. Methods: We searched multiple databases from inception to December 2022. We included randomized controlled trials (RCTs) with any type of pain population, including acute and chronic pain; exercise interventions were compared to sham exercise or other active interventions. The primary outcomes were TMS metrics, and pain intensity was the secondary outcome. Risk of bias assessment was conducted using the Cochrane tool. Results: This review included five RCTs (n = 155). The main diagnoses were fibromyalgia and cervical dystonia. The interventions included submaximal contractions, aerobic exercise, physical therapy, and exercise combined with transcranial direct current stimulation. Three studies are considered to have a high risk of bias. All five studies showed significant pain improvement with exercise. The neurophysiological data revealed improvements in cortical excitability measured by motor‐evoked potentials; standardized mean difference = 2.06, 95% confidence interval 1.35–2.78, I2 = 19%) but no significant differences in resting motor threshold. The data on intracortical inhibition/facilitation (ICI/ICF) was not systematically analyzed, but one study (n = 45) reported higher ICI and lower ICF after exercise. Conclusions: These findings suggest that exercise interventions positively affect pain relief by modifying corticospinal excitability, but their effects on ICI/ICF are still unclear. While the results are inconclusive, they provide a basis for further exploration in this area of research; future studies should focus on establishing standardized TMS measurements and exercise protocols to ensure consistent and reliable findings. A large‐scale RCT that examines various exercise interventions and their effects on cortical excitability could offer valuable insights to optimize its application in promoting neuroplasticity in pain populations. [ABSTRACT FROM AUTHOR]