„Fixed dystonia“ syndrome after peripheral trauma in two adolescent girls

We report two adolescent girls who developed dystonia of lower extremities after a peripheral trauma. The first girl was a 11;4 year old, who did the splits accidently when she was roller scating. After that she developed a painful hip and fixed dystonic posturing of her left hip and leg. Torsion of the trunk could be observed as well. The other patient was a 15 year old girl with a bilateral spastic cerebral palsy (GMFCS II) who was operated for coxa vara antetorta with a derotation-varisation osteotomy. After the operation she developed painful dystonic inversion of both feet. Subsequently she was unable to walk for weeks. She developed severe contractures in her feet and had to be operated again.

In both patients a peripheral trauma induced dystonic symptoms which lasted for months and were difficult to treat. The syndrome of „fixed dystonia“ has been described in adult patients: It comprises a variety of symptoms including a movement disorder, elements of the complex regional pain syndrome (CPRS I) and psychiatric problems. Often the symptoms develop after a relatively harmless trauma. Frequently the diagnosis of a psychogenic movement disorder is made. There is a clear female preponderance. The clinical signs of typical idiopathic dystonia are missing.

Prognosis is best, if therapy consists of multidisciplinary approach including physiotherapy and psychological support. Invasive procedures should be avoided and treatment should be started as early as possible. The optimal setting would be a neuropaediatric rehabilitation treatment.

(e.g. Majumdar et al. Europ J Pediatr Neurol 2009;13: 466–472)