Torsion spasm

Introduction Torsion spasm, also known as idiopathic torsion spasm (ITS), torsion dystonia, primary dystonia, clinical dystonia and limbs, The trunk is characterized by intense and involuntary torsion throughout the body. It is divided into primary and secondary, and primary is more common. The pathological changes of primary dystonia have not been affirmative. There was no obvious abnormality in the striatum and globus pallidus in the brain tissue of patients with hereditary type. The plasma levels of dopamine--hydroxylase and norepinephrine were increased in patients with dominant hereditary type.

Cause

Causes

1. Idiopathic torsion is caused by unknown causes, mostly scattered, and a few have a family history. A number of studies have shown that approximately 85% of patients with torsion spasm have a lower penetrance autosomal dominant gene, and a small number of people have new mutations. Whether there are autosomal recessive or X-linked genetic types in the average person is not certain. In the relatives of the first generation of the genetic family, the risk of disease is about 20%.

2. Symptomatic torsion is seen in various diseases involving the basal ganglia, such as infection (after encephalitis), degeneration (hepatolenticular degeneration, Hallervorden-Spatz disease), poisoning (especially CO and levodopa, phenothiazine) Or excessive butyrylbenzene), metabolic disorders (basal nucleus calcification, brain lipid deposition), trauma and tumors.

an examination

1. Ask about medical history

Twisting sputum is mainly the involuntary squat and twist of the trunk and limbs, but the shape of this movement is strange and changeable. The onset is slow, often starting from one foot or both feet, with sacral flexion. Once the limbs are affected, the proximal muscles are heavier than the distal muscles, and the cervical muscles are invaded to the sacral torticollis. The involvement of the trunk muscles and the paraspinal muscles causes a systemic torsion or spiral motion as a characteristic manifestation of the disease. Twisting and aggravating during exercise or stress, and the twisting action disappears during quiet or sleep.

2. Laboratory inspection:

Blood electrolytes, drugs, trace elements and biochemical tests help to differentiate diagnosis and classification.

(1) CT, MRI examination

Positron emission tomography (PET) or single photon emission tomography (SPECT) is useful for differential diagnosis.

(2) Genetic analysis

It is important for the diagnosis of certain hereditary dystonia diseases.

Differential diagnosis

Enthusiasm: It is a phenomenon of high temperature heatstroke. Working under dry and hot conditions, sweating excessively, and a lot of NaCl is discharged with sweat, and the limbs and abdominal wall muscles are paralyzed. The patient's temperature does not rise. Supplemental saline can be alleviated. Enthusiasm is usually the first warning of collapse caused by heat. After overwork, the muscles in the arms, legs and abdomen will occur. This is usually caused by lack of body salt (because of excessive sweating, especially insufficient salt). Time).

Vulnerability: Also known as acromion or finger movement, it is characterized by an increase in the distal muscles of the limbs and a decrease in the movement of the muscles, and a slow, creepy, wriggle-like peristalsis. Similar to dystonia, it is not an independent disease unit. It is a relatively slow, untargeted, continuous involuntary motor syndrome in the fingers, toes, tongue, or other parts of the body.

Writing snoring: It is due to occupational factors that have been engaged in fine hand movements for a long time. From two causes of muscle spasm in the hand, a symptom group mainly characterized by writing dysfunction occurs. Blood electrolytes, drugs, trace elements and biochemical tests are helpful for differential diagnosis.

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