Benign paroxysmal torticollis

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Benign Paroxysmal Torticollis

Benign Paroxysmal Torticollis (BPT) is a rare neurological disorder that typically affects infants and young children. It is characterized by recurrent episodes of head tilting, which may be accompanied by vomiting, irritability, and pallor. The condition is considered benign because it usually resolves spontaneously by the age of five.

Clinical Presentation

Children with BPT experience episodes where the head tilts to one side. These episodes can last from a few hours to several days. During an episode, the child may also exhibit:

  • Nausea and vomiting
  • Irritability
  • Pallor
  • Ataxia

The frequency of episodes can vary, with some children experiencing them monthly, while others may have them less frequently.

Pathophysiology

The exact cause of BPT is not well understood. It is thought to be related to a dysfunction in the vestibular system, which is responsible for maintaining balance and spatial orientation. Some researchers suggest a genetic component, as BPT can run in families.

Diagnosis

Diagnosis of BPT is primarily clinical, based on the characteristic symptoms and the exclusion of other conditions. A thorough medical history and physical examination are essential. In some cases, additional tests such as MRI or CT scans may be conducted to rule out other causes of torticollis.

Differential Diagnosis

BPT must be differentiated from other causes of torticollis, such as:

Management

There is no specific treatment for BPT, as the condition is self-limiting. Management focuses on supportive care during episodes. Parents are advised to provide comfort and reassurance to the child. In some cases, medications such as antiemetics may be used to alleviate symptoms like nausea and vomiting.

Prognosis

The prognosis for children with BPT is excellent. Most children outgrow the condition by the age of five, with no long-term effects. Regular follow-up with a pediatrician is recommended to monitor the child's development and ensure that symptoms resolve.

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Contributors: Prab R. Tumpati, MD