Facial spasm and tic, torticollis : diagnosis and treatment / by Tom A. Williams.

  • Williams, Tom A. (Tom Alfred), 1870-
Date:
1910
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Licence: In copyright

Credit: Facial spasm and tic, torticollis : diagnosis and treatment / by Tom A. Williams. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    >/ (Reprinted from Monthly Cyclopedia and Medical Bulletin, January, 1910.1 the author’s complin FACIAL SPASM AND TIC; TORTICOLLIS—DIAGNOSIS AND TREATMENT. Bt TOM A. WILLIAMS, M.B., C.M. (Edin.), WASHINGTON, D. 0. Though not dangerous to life, few affections are more troublesome to their victim than the facial grimaces and twistings of the neck comprised in the above titles. The patients are willing to take great pain to get rid of the unpleasant gestures, which though not painful in themselves, cause a great deal of moral suffering, besides interfering with efficiency both in business and social life. The obstinacy of these afflictions has caused them to be looked upon with despair by practitioners; and the following considerations are intended to show that medical pessimism with regard to them is not well-founded; that' they are in reality most amenable to treatment; but that the indications for this depend upon a clear diagnosis, the main elements of which I shall briefly indicate and illustrate by cases. The crucial problem is the distinction between a true spasm1 which is an irritation of some part of a reflex arc by an alteration of structure or perhaps biochemically, as against a true tic which is a movement dictated quasi- volitionally, not necessarily the result of an irritation in the periphery but inspired by an idea, desire, imperative need, i.e., psycho-genetically. This is a real and practical distinction, and not merely academic; for from its appreciation flows one’s choice of surgery, medicine or psychotheraphy as the remedial agent.2 For succinctness, the main diagnostic distinctions are collected in the following table, and further elucidated in the commentary and cases which follow. I have not gone into the details of treatment, that of the surgeon not coming within my province; while the medical and psychic measures would require so much space for their description as to unduly prolong this article. The main principles, however, are described elsewhere16; and the technique of their application has now been mastered by a considerable number of neurologists. My main object in this paper is to emphasize the extreme importance of correct diagnosis. Spasm. Tic. Chorea. Cerebellar and Rubro- spinal Tremor. Sudden, resembling electrical stimulation. Rhythmic and syn- chronous, or in light- ening waves of same movement. Brusque and brief, slower. In volleys of similar movement repeatedly. Still slower. Irregular, not syn- chronous. Extreme variability in movement, with tendency to unilater- ality. Not sudden but regu- lar and increasing by movement. Similar oscillations.