Table (E)-1. Etiological and clinical characteristics of patients with camptocormia

/ Age/
Sex / Family Hx / Latency
(Duration)
camptocormia,
yr / Predisposing
(comorbid)
Conditions / Specific feature of camptocormia/
Sensory tricks / Imaging studies / BTX
Dosage
(Units)/
Muscles injected / Response To BTX/ Total
Duration of response (Weeks)
Parkinson’s disease
1 / 63
M / Y / 6 (4) / (Sleep apnea) / Able to straighten back with effort / MRI brain-NL / 150/RA
200/PS / NR
2 / 74
M / Y / 10 (3) / S/p fall, chronic low back pain, Hx of exposure to glue and glue accelerant in airplane / Scoliosis to R, contractions of RA and R paravertebral muscles / Spine-series -degenerative disc changes C4-C7, anterior spurring of T spine. / 400/RA
200/PS / GR/14
3 / 74
F / N / 2 (2) / (RLS) / Band feeling around abdomen, camptocormia 45 / MRI-brain NL / 300/RA / GR/24
4 / 91
F / Y / 1 (13) / Hx of multiple abdominal surgeries / Camptocormia without any abdominal muscle spasms / MRI brain-chronic ischemic changes, CT Myelogram-severe stenosis L3-L4, L4-5. / — / —

Table (E)-1. (cont.)

Age/
Sex / Family Hx / Latency
(Duration)
camptocormia,
yr / Predisposing
(comorbid)
Conditions / Specific feature of camptocormia/
Sensory tricks / Imaging studies / BTX
Dosage
(Units)/
Muscles injected / Response to BTX/ Total
Duration of response (Weeks)
5 / 66
M / N / 2 (6) / S/p fall – R humerus fracture, stenosis at L3,L4 and L5, back pain (sleep apnea) / Camptocormia 90 / — / Unknown/
PS / NR
6 / 77
M / N / 3 (5) / S/p fall from height, back pain / Camptocormia 90 / — / — / —
7 / 69
M / N / 9 (1) / (REM sleep disorder) / Active contractions of RA, submental complex and scoliosis/ Holding forehead to straighten the neck / MRI brain-NL / 400/RA / GR/8
8 / 75
M / N / 14 (4) / (Dementia, ET) / Severe camptocormia with hip and spine flexion with head in between the knees / — / — / —

Table (E)-1. (cont.)

Age/
Sex / Family Hx / Latency
(Duration)
camptocormia,
yr / Predisposing
(comorbid)
Conditions / Specific feature of camptocormia/
Sensory tricks / Imaging studies / BTX
Dosage
(Units)/
Muscles injected / Response to BTX/ Total
Duration of response (Weeks)
9 / 66
M / Y / 23(2) / (ET, dementia) / Camptocormia 90 / Abdominal series-NL / — / —
10 / 57
F / N / 20 (7) / S/p adrenal medullary transplant, s/p bilateral pallidotomy, s/p lumbar surgery / Difficulty maintaining upright position, marked bilateral PS spasm / --- / Unknown/
PS / NR
11 / 67
M / Y / 3 (2) / S/p fusion surgery T5- L4, back pain, (sleep apnea) / Able to straighten back on sitting/recumbent position / Spine series-extensive posterior fusion T5-L4 / — / —
Primary Generalized (Axial) Dystonia
12 / 88
M / N / 0 (5) / — / Camptocormia while ambulating/Pressing left thigh straightens the back / MRI-Spine-moderate spondyllosis, Hemangioma at T3, T8 and L1 / — / —

Table (E)-1. (cont.)

Age/
Sex / Family Hx / Latency
(Duration)
camptocormia,
yr / Predisposing
(comorbid)
Conditions / Specific feature of camptocormia/
Sensory tricks / Imaging studies / BTX
Dosage
(Units)/
Muscles injected / Response to BTX/ Total
Duration of response (Weeks)
13 / 34
F / N / 0 (14) / Generalized dystonia / Generalized dystonia with camptocormia, extreme anterocollis / CT- enlarged cisternal spaces, post parietal atrophy / Unknown/ PS / NR
Peripherally induced abdominal dystonia
14 / 61
F / N / 0 (3) / S/p laminectomy L4-L5, back spasms / Severe contractions of abdominal muscles with pain, flexed knees on standing, relief with sitting or lying / MRI Spine –post laminectomy changes / 600/RA
200/PS / NR
Abdominal dystonia secondary to syringomyelia
15 / 49
F / N / 0 (1) / — / Episodic abdominal muscle spasms with dystonic posture / triggered by touching back, R inguinal area or sitting with R leg flexed / MRI Spine-syringomyelia from C7-T7 / — / —

Table (E)-1. (cont.)

Age/
Sex / Family Hx / Latency
(Duration)
camptocormia,
yr / Predisposing
(comorbid)
Conditions / Specific feature of camptocormia/
Sensory tricks / Imaging studies / BTX
Dosage
(Units)/
Muscles injected / Response to BTX/ Total
Duration of response (Weeks)
Tourette syndrome
16 / 25
F / N / 15 (1) / (OCD, migraines) / Repetitive bending of the trunk/ urge to bend / — / 300/PS / PR/16

Hx = History; BTX = Botox; MRI = Magnetic Resonance Imaging; NL = Normal; RA = Rectus abdominus; PS = Paraspinal; NR = No response; GR = Good response; RLS = Restless legs syndrome; CT = Computerized Tomography; REM = Rapid eye movement; ET = Essential tremor; OCD = Obsessive Compulsive Disorder.

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Table (E)-2. Clinical characteristics and treatment outcome of reported cases of camptocormia

Reference
Number / Sex / Mean
Age / Etiology/Predisposing
Factors / Treatment /Response
31 / 1F / 38 / Conversion disorder;
Acute onset / Psychotherapy [GR]
32 / 1M / 22 / Conversion disorder;
Back pain / Muscle relaxants & PT [NR];
Release from active duty (complete relief)
38 / 1M / 29 / Conversion disorder, triggered by sciatica; 90°CC / Epidural anesthesia [PR];
PT [NR]
39 / 1F / 31 / Psychogenic; S1 radiculopathy / Epidural block [NR]; psychotherapy [GR]
40 / 1M / 18 / Mood disorder; Remote Hx of foot ball injury / Psychotherapy & amitriptyline [GR]
33 / 6 N/A / 22 / Conversion disorder; Prior Hx of back injury / Psychotherapy [GR (1); Lost for follow up (5)]
34 / 1M / 36 / Conversion disorder; Prior Hx of head injury in the army / Carbamazepine [―]
35 / 1M, 1F / 53 / Psychogenic; Normal EMG and Myelogram. / Psychotherapy [―]
8 / 5M, 22F / 69 / Primary muscular disease. / [―]
41 / 1F / 75 / Myopathy / Prednisolone [NR]
42 / 1M / 47 / CC as a kinematic abnormality due to excessive anterior pelvic tilt / PT [GR]
43 / 1M / 49 / Paraneoplastic syndrome of Non-Hodgkin's lymphoma / PT, hydrotherapy, dorso-lumbar corset, and chemotherapy [NR]

Table (E)-2. (cont.)

Reference
Number / Sex / Mean
Age / Etiology/Predisposing
Factors / Treatment /Response
5 / 2M, 6F / 66 / PD / L-dopa started soon after onset [GR (4)]
L-dopa initiation delayed [NR (4)]
4 / 1M, 1F / 72 / Right putaminal infarct (1); Right lenticular hemorrhagic infarct (1) / L-dopa [NR (1)]
PT [GR (1&2)]
44 / 1M / 57 / Amyotrophic lateral sclerosis;
Diffuse muscle cramps / [―]
20 / 1M / 75 / PD (CC as a form of dystonia) / L-dopa [NR]
9 / 1M / 63 / PD; CC with pain s/p enteral infection; Focal myositis on Bx / Steroids [GR]
45 / 1M / ― / PD / Bilateral GPI DBS [GR]
55 / 20F, 3M / 73 / Primary acquired lumbar kyphosis / [—]
46 / 1F / 49 / PD (CC as a form of dystonia) / L-dopa, pergolide, muscle relaxants, NSAIDS [NR]
Right pallidotomy[GR]
6 / 4M / 66 / MSA (1); PD (2); ET/PD (1) / Ldopa, bromocriptine, pergolide, pramipexole,amantadine, Bilateral STN [NR]
L1S1 spine surgery [GR (1)]
23 / 1F / — / Autosomal recessive juvenile parkinsonism; Parkin gene; Truncal dystonia / L-dopa [NR]
21 / 2M / 66 / PD (CC as a form of dystonia) / L-dopa, gabapentin, clonazepam, and baclofen, ropinirole [NR]

Table (E)-2. (cont.)

Reference
Number / Sex / Mean
Age / Etiology/Predisposing
Factors / Treatment /Response
56 / 7 Unk / 73 / PD / L-dopa [—]
57 / 1M / 48 / Motor Neuron Disease / [—]
58 / 1F / 15 / Oppositional defiant disorder and MR / Psychotherapy[GR]
present series / 9M, 6F / 65 / PD (11); TS (1); Abdominal dystonia (4) / L-dopa (PR or NR (12); BTX [GR (4/9)]; DBS [NR (1)]

GR = Good response; PR = Partial response; NR = No response; PT = Physical therapy; Hx = History; CC = Camptocormia; PD = Parkinson’s disease; EMG = Electromyography; Bx = Biopsy; GPI = Globus pallidus internus, DBS = Deep brain stimulation; NSAIDS = Non steroidal anti-inflammatory drugs; BTX = Botulinum toxin injections; STN = Subthalamic nucleus; MSA = Multiple system atrophy; ET = Essential tremor; MR = Mental retardation.

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