SPASMUS NUTANS - A SERIES OF 16 CASES

Spasmus nutans is a syndrome occurring in early childhood. It consists of a triad of symptoms: head nodding, ocular oscillations and anomalo us head position. Ophthalmologic and neurological findings are otherwi se normal. This syndrome is benign and has spontaneous resolution. Pat ients and method. - Sixteen patients with spasmus nutans seen from 198 0 to 1995 were retrospectively studied Their present status was evalua ted by clinical examination or questionnaire. Results. - The age at on set ranged from 1 to 15 months (average 7 months). Thirteen of 16 pati ents were referred for head nodding, which was a constant manifestatio n; its direction was horizontal, vertical or rotarory. Nystagmus was p resent in 14 infants. It was acquired, asymmetrical, bilateral (or uni lateral in three cases), rapid, fine, pendular and horizontal. Both he ad nodding and nystagmus were intermittent. Anomalous head position wa s present in seven cases, consisting of head tilt or a chin upon/chin down posture. Neuroimaging (13 cases) was always normal. The following in 12 children (up to 2 years) showed a complete resolution of the sy ndrome in 6 months to 6 years (average 2.5 years). Discussion. - The d iagnosis was established by the constancy of the characteristic triad and the elimination of the other causes of nystagmus. Isolated head no dding had to be distinguished from bobble head syndrome, In several re ported cases, electronystagmography recordings have suggested that hea d nodding is a compensatory process against nystagmus and that the hea d tilt allows transient resolution of the nystagmus. Conclusion. - Spa smus nutans is a self-limiting benign clinical entity. Normal complete ophthalmologic and neurological examination, as well as magnetic reso nance imaging (MRI) are necessary to confirm the diagnosis. (C) 1998 E lsevier, Paris.