Dropped head in Parkinson’s disease

Abstract

"A propensity to bend the trunk forward" and "the chin is now almost immovably bent down upon the sternum" were described by James Parkinson in patients with Parkinson's disease (PD). The term "dropped head" was first reported in "Gerlier disease" in Switzerland and 'kubisagari' in Japan and since then also reported in myositis, myopathy, myasthenia gravis, amyotrophic lateral sclerosis, neuropathy, and hypothyroidism. Disproportionate antecollis occurs in about half cases of multiple system atrophy (MSA) and is considered dystonic in nature. Dropped head is considered rare in PD, both in advanced and early stages of PD. However, it is known to progress subacutely over a period of several days. In my experience, dropped head is relatively common in PD. The mechanism of dropped head in PD is either dystonia of flexor neck muscles or weakness of extensor neck muscles. The response of dropped head to various anti-parkinsonian medications is rather inconsistent. Levodopa is reported to induce amelioration in some patients while dopamine agonists can cause deterioration. Muscle afferent block with lidocaine and ethanol is reported to be effective, while the effect of botulinum toxin injection into the affected muscles is limited. The effect of stereotaxic neurosurgery on dropped head is controversial. Early diagnosis and prompt treatment is necessary to prevent muscle damage associated with longterm overstretch of extensor neck muscles.

Immune Mediated Necrotizing Myopathy: a Cause of Isolated Myopathy of Neck Extensor Muscle

“…Myositis of the neck flexors in IIM is common, although weakness of the neck extensors resulting in dropped or floppy head is very rare. 7 Individual case reports of dropped head have been described in Parkinson's disease 8 and after hemispheric striatal infarction. 9 Nine cases of dropped head syndrome associated with systemic autoimmune diseases have also been described.…”

“…Responsive to treatment with dopamine agonists or muscle afferent block of sternocleidomastoid. 8 Acute ischemic stroke One case report. 9 Abnormal MRI brain and presence of other focal neurologic deficits.…”

Orthopedic Complications of Parkinson's Disease

“…In reality, anterocollis or "dropped head" (Figure 33.6) is more commonly observed in patients with MSA [44], whereas neck extension or retrocollis is more frequently found in PSP and tardive syndromes [2]. The incidence of dropped head in PD has not been extensively investigated, but it is probably around 5-6% [45,46]. When present, anterocollis in PD may progress either slowly or subacutely over a period of several days, causing important disability [45].…”

“…The incidence of dropped head in PD has not been extensively investigated, but it is probably around 5-6% [45,46]. When present, anterocollis in PD may progress either slowly or subacutely over a period of several days, causing important disability [45].…”

Prevalence and type of cervical deformities among adults with Parkinson's disease: a cross-sectional study

“…Antecollis has a reported prevalence of approximately 6% in PD, 2,6 and, when severe, the neck drop of antecollis can be markedly more pronounced relative to the expected flexed posture of the trunk and limbs. 30 This classic stooped appearance of PD may be associated with cervical malalignment in the setting of relatively normal global sagittal alignment, which can result in significant difficulty with swallowing, excessive drooling, and limitations in horizontal gaze secondary to neck flexion.…”