Dramatic Response of Dropped Head Sign to Treatment with Steroid in Parkinson's Disease: Report of Three Cases

Hemmi, Shoji; Kurokawa, Katsumi; Izawa, Nana; Kutoku, Yumiko; Murakami, Tatsufumi; Sunada, Yoshihide

doi:10.2169/internalmedicine.50.4395

Cited by 6 publications

(4 citation statements)

References 26 publications

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“…Electromyography (EMG) showed short-duration, low-amplitude motor unit potentials with reduced recruitment patterns in the paraspinal muscles at the C5 spinal Because the STIR high signal intensity was limited to the posterior neck muscles, we considered isolated neck extensor myopathy (INEM). [1][2][3] However, based on extensive muscle atrophy and radiation-associated findings, the patient was diagnosed with DHS due to chemoradiotherapy. Unfortunately, he died from aspiration pneumonia a year later.…”

Section: Descriptionmentioning

confidence: 99%

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Dropped head syndrome due to chemoradiotherapy for nasal lymphoma, characterised by short tau inversion recovery high signal intensity in the cervical paraspinal muscles

et al. 2022

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Section: Descriptionmentioning

confidence: 99%

“…Because the STIR high signal intensity was limited to the posterior neck muscles, we considered isolated neck extensor myopathy (INEM) 1–3. However, based on extensive muscle atrophy and radiation-associated findings, the patient was diagnosed with DHS due to chemoradiotherapy.…”

Section: Descriptionmentioning

confidence: 99%

Dropped head syndrome due to chemoradiotherapy for nasal lymphoma, characterised by short tau inversion recovery high signal intensity in the cervical paraspinal muscles

et al. 2022

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“…Patients with severe pain in the extensor muscles may present with acute inflammation. Hemmi et al reported that steroid pulse therapy had significant effects on DHS caused by myopathy [ 4 ]; however, it did not have an effect on DHS caused by other conditions.…”

Section: Introductionmentioning

confidence: 99%

Lidocaine injections and neck corset wearing improve dropped head syndrome in Parkinson's disease and related disorders

Mukai

Furusawa

Morimoto

et al. 2019

Clinical Parkinsonism & Related Disorders

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Background Patients with Parkinson's disease and related disorders (PDRD) may exhibit dropped head syndrome (DHS), which does not yet have an effective treatment. Objectives To evaluate the effect of combining lidocaine injection into the bilateral scalene muscles and neck corset wearing on dropped head syndrome. Methods We performed needle electromyography assessments of the scalene, sternocleidomastoid (SCM), levator scapulae, splenius capitis, and trapezius muscles. Patients received 2.5–5 ml injections of 1% lidocaine into both sides of the scalene muscles for 4/5 consecutive days and were instructed to wear a neck corset. We measured the neck flexion angle, which formed between the horizontal line and the straight line passing through the ear canal and orbital fossa, before (baseline) and after (Day 8 and Day 90) the intervention. Results Seven males and eight females (mean age, 68.9 years; range 56 to 85 years) who had PDRD with dropped head syndrome were enrolled in this study. Needle electromyography examination revealed abnormal discharge of the scalene muscles in all patients when the neck position was corrected; however, some patients did not show abnormal discharge of the SCM muscle. At Day 8, we observed an improvement of the neck flexion angle in 13 of the 15 patients, from an average of 27.7° ± 13.9° to 11.7 ± 14.6°. At Day 90, the average neck flexion angle was 15.3° ± 17.2°. Conclusions Combining lidocaine injection into the scalene muscles and neck corset wearing is an effective treatment regimen for DHS in patients with PDRD.

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“…For those patients who showed any evidence of focal myopathy, we attempted steroid treatment, and evaluated their effects against DHS. A preliminary report regarding three cases of the present series has been published elsewhere …”

Section: Introductionmentioning

confidence: 99%

Focal myopathy in the neck extensor muscles in Japanese Parkinson's disease patients with dropped head syndrome

Kurokawa

Sonoo

Hemmi

et al. 2013

Neurology & Clinical Neurosc

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Aim: The underlying etiology of dropped head syndrome (DHS) in Parkinson's disease (PD) patients seems to be heterogeneous, that is neck dystonia, a druginduced etiology or focal myopathy of the neck extensor muscles. Focal myopathy might be primary myositis or a stretched muscle injury. In Japan, several reports have argued that neck dystonia is the cause of DHS. There have been no reports to date that documented a focal myopathy of the neck extensor muscles. The aim of the present study was to investigate myopathic changes in the neck extensor muscles of PD patients with DHS by needle electromyography (EMG), and to evaluate the effect of steroid therapy. Methods: We carried out needle EMG on 15 consecutive PD patients with DHS who visited our hospital between July 2009 and November 2011. The effects of prednisolone for the treatment of DHS were evaluated clinically and electrophysiologically. Results: Needle EMG of the neck extensor muscles in 15 PD patients with DHS revealed fibrillation potentials, positive sharp waves and small amplitude, short duration motor unit potentials in 14 patients. EMG findings were indicative of focal myopathy in five patients, and were compatible with focal myopathy in nine patients. DHS improved in eight out of 11 patients given prednisolone 20 mg/day. Follow-up needle EMG after steroid therapy in four patients showed improvements in the myopathic changes. Conclusion: We report that focal myopathy of the neck extensor muscles is common in Japanese PD patients with DHS. Our findings suggest that steroid therapy might improve DHS in some PD patients.

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Dramatic Response of Dropped Head Sign to Treatment with Steroid in Parkinson's Disease: Report of Three Cases

Cited by 6 publications

References 26 publications

Dropped head syndrome due to chemoradiotherapy for nasal lymphoma, characterised by short tau inversion recovery high signal intensity in the cervical paraspinal muscles

Dropped head syndrome due to chemoradiotherapy for nasal lymphoma, characterised by short tau inversion recovery high signal intensity in the cervical paraspinal muscles

Lidocaine injections and neck corset wearing improve dropped head syndrome in Parkinson's disease and related disorders

Focal myopathy in the neck extensor muscles in Japanese Parkinson's disease patients with dropped head syndrome

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