Spasmus Nutans

SPASMUS NUTANS, or rotatorius (nodding or rotational spasm), a nervous disease of infancy or early childhood, characterized by nystagmus, involuntary movements, and abnormal head positioning, occurring predominantly in spring and disappearing without trace after several months. The disease is generally not common (according to Zappert, 1-3 cases occur per 3,000-4,000 sick children). Usually children aged from 6 months to 2 years fall ill, when the first attempts are made to sit and walk, i.e., during the period of development of static functions. Of the triad characteristic of this disease, the nodding movements of the head and nystagmus are most constant. The head movements have the character of affirmation or rotation, less frequently negation. They are particularly distinct during rest and disappear when the child voluntarily innervates the neck muscles during crying, agitation. They also disappear if the eyes revealing nystagmus are bandaged. With certain directions of gaze, the movements intensify. Nystagmus has an oscillating or rotational character, intensifying or generally only appearing with certain directions of the eyes. Sometimes unilateral nystagmus is observed. Often nystagmus can be detected only by fixing the child's head with hands. - The abnormal position of the head is most often expressed in the form of tilting the head backward or to the side. The mentioned symptoms do not develop simultaneously. There are cases where the disease begins with an abnormal position of the head or nodding movements, followed by nystagmus, in others only nystagmus is observed at first. Fatigue, despite the head movements lasting all day, is not observed. At night the movements cease. Children from poorer classes, living in unfavorable conditions and dark rooms, are more frequently affected. Rickets, tetany and other diseases, however, play no role. The disease usually begins gradually, reaches full development after several weeks and lasts from several months to a year, after which the intensity of symptoms begins to decrease and gradually disappears, leaving no disturbances of the nervous system. In view of the typical picture of the disease, diagnosis presents no particular difficulties. All other pathological conditions associated with convulsive contractions of the neck and occipital muscles, such as salaam convulsions, have nothing in common with nodding spasm and belong to epilepsy. Nystagmus caused by eye anomalies, of course, also does not belong here. Nodding spasm does not respond to treatment. Complete recovery occurs without any intervention. Pathogenesis. The question of the pathogenesis of nodding spasm cannot yet be considered finally clarified. Raudnitz (Raudnitz), the first to study this disease in detail, was able to note that the sick children he observed lived in dark rooms or poorly lit corners of apartments - a circumstance confirmed later by a number of other authors. Raudnitz therefore assumes that the involuntary tendency of children to constantly fix a meager source of light tires the eye muscles and thereby causes weakening of fixation, leading to nystagmus. Irritation of the overstrained nuclei of the oculomotor nerves radiates to the nuclei of the neck and occipital muscles, which leads to involuntary movements of the head. Congenital or acquired anomalies of the visual apparatus contribute to the appearance of these involuntary movements. The fact that the conditions noted by Raudnitz are not always present, as well as observations on the nystagmus of coal miners and experimental research by ophthalmologists and otologists, have supplemented and to some extent modified Raudnitz's hypothesis, and at present it should be assumed that nodding spasm is caused by lesions of both the visual apparatus and the labyrinth. In this case, both external causes and individual properties are important; both relate to the eye and the ear. The main symptoms of nodding spasm, such as nystagmus, head movements, and its involuntary position, can be caused by a lesion of the labyrinth. As vestibular irritation, the irritations associated with the beginning of sitting and walking act, which, according to Shur's research, are in a state of increased excitability during this period. The cause of the lesion of the visual apparatus should be considered the darkness of the room in which most of these children live.