CASE REPORT ‘‘Visual sensory trick’’ in patient with cervical dystonia Chan-Nyoung Lee • Mi-Yeon Eun • Do-Young Kwon • Moon Ho Park • Kun-Woo Park Received: 29 April 2011 / Accepted: 20 October 2011 / Published online: 10 November 2011 Ó Springer-Verlag 2011 Abstract Sensory tricks are clinical maneuvers that may partially relieve dystonic contractions. Any clinical maneu- ver that modulates afferent sensory and efferent motor pathways could be used as a sensory trick in patients with cervical dystonia. Although various sensory tricks have been described to reduce cervical dystonia, little is known about the exact mechanisms by which they operate. We report a case of cervical dystonia that was alleviated through the use of a visual-sensory trick. Our findings suggest that visual stimulation might be an effective sensory trick in cervical dystonia by compensating for a defective sensory system, or because visual pathways might be also affected by sensory interactions in cervical dystonia. Keywords Cervical dystonia Á Sensory trick Á Vision Introduction Cervical dystonia is characterized by sustained, involuntary contraction of the cervical muscles resulting in abnormal head movements or postures. Cervical dystonia is the most common type of focal dystonia and the majority of cases are idiopathic [1–3]. The use of sensory tricks (gestes antagoniste), such as simple touches or specific gestures, is a well-known clinical maneuver by which involuntary muscle contractions are partially and transiently relieved in cervical dystonia, but the mechanisms by which sensory tricks function remains unknown [4]. Impairment of sensorimotor integration is thought to be implicated in the pathophysiol- ogy of dystonia, and it is proposed that sensory tricks may provide additional sensory information regarding abnormal head positions and therefore cause partial correction of head position. We report a patient who experienced relief from cervical dystonia after several visual manipulations. To our knowledge, this is the first demonstration of visual maneuver as a novel sensory trick that was effective for the symp- tomatic relieving of cervical dystonia. Case report A 45 year-old woman visited our institution complaining of involuntary neck rotation and head tilt that had persisted for more than 5 years. She presented with torticollis and laterocollis to the right side with null point and lateral shift on examination without associated pain. The patient’s dystonia was aggravated by daily activities, such as walking. The patient reported difficulty performing simple housework, reading a book, or watching a movie. Her total Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) [5] score upon presentation was 38 (severity scale 16, disability scale 19, and pain scale 3). The patient’s involuntary muscle contractions of the neck were relieved by classical sensory tricks such as touching her cheek and grasping the posterior neck. She also noted interesting phenomenon that her dystonic movements reduced with visual maneuvers, such as looking at herself in the mirror. Further examination revealed that other visual sensory tricks such as staring at a specific target and focusing on stationary objects while walking were also C.-N. Lee Á M.-Y. Eun Á D.-Y. Kwon Á M. H. Park Á K.-W. Park Department of Neurology, Korea University College of Medicine, Ansan, Republic of Korea D.-Y. Kwon (&) Department of Neurology, Korea University Ansan Hospital, 516 Gojan-1-dong, Danwon-gu, Gyeonggi-do, Ansan 425-707, Republic of Korea e-mail: kwondoya@hanmail.net 123 Neurol Sci (2012) 33:665–667 DOI 10.1007/s10072-011-0831-x