Q. I have breathing problem and my head is unable to be lifted without opening the mouth. Please help.

Answered by
Dr. Riazahmed Syed
and medically reviewed by Dr. Nithila A

Hello doctor,

I have some problems to breathe, and my head goes side to side. I was wondering if this is a normal head shape? And not be able to lift it without having the mouth completely open, so the jaw hurts. Please help.

Dr. Riazahmed Syed

Child Health Neurology

Hello,

Welcome to icliniq.com.

I saw the pictures, and it seems you have action induced focal dystonia (attachment removed to protect patient identity). Please tell me how long you have these symptoms, and how does it come and get settled? Does it persist for some time? Again do you have any more stiffness elsewhere in the body? You can get an MR brain, as well as serum copper or ceruloplasmin levels, done. You try a course of L-Dopa 25 mg tid (thrice a day) in the meantime. If not alleviating, you can see a movement disorder specialist.


The Probable causes:

Idiopathic. But there are many more tests to rule out secondary causes. Genetic tests are available

Investigations to be done:

MR brain, copper, and ceruloplasmin.

Differential diagnosis:

Secondary dystonia.

Probable diagnosis:

Focal action dystonia? DOPA responsive.

Treatment plan:

L-Dopa for a period of six months.

Preventive measures:

To see the progression of disability.

Thank you doctor,

So you believe this is a normal head? Because I have never been able to keep my head still since I was a child. And it happens as soon as I open my mouth. My head falls back as soon as I open the mouth. I feel it in the neck. May you cannot see it. But I can feel when I open my mouth, and my head falls backward.

Dr. Riazahmed Syed

Child Health Neurology

Hello,

Welcome back to icliniq.com.

Jaw head dyskinesia and again a sort of dystonic trigger movement only. As long as it does not affect your day to day routine, it can be left alone as habitual. A trial L-Dopa (Sinemet) to see the response is worthwhile.


The Probable causes:

Idiopathic.

Investigations to be done:

Already discussed regarding it and since it is from birth and non-progressive no need.

Differential diagnosis:

Habitual spasms.

Probable diagnosis:

Dystonia of focal.

Treatment plan:

Trial Sinemet 25 mg tid (thrice a day) for a month.

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