Abstract
Background
In recent years, camptocormia and dropped head syndrome (DHS) have gained attention as particular forms of movement disorders. Camptocormia presents with involuntary forward flexion of the thoracolumbar spine that typically increases during walking or standing and may severely impede walking ability. DHS is characterized by weakness of the neck extensors and a consecutive inability to extend the neck; in severe cases the head is fixed in a “chin to chest position.” Many diseases may underlie these conditions, and there have been some reports about radiation-induced camptocormia and DHS.
Methods
A PubMed search with the keywords “camptocormia,” “dropped head syndrome,” “radiation-induced myopathy,” “radiation-induced neuropathy,” and “radiation-induced movement disorder” was carried out to better characterize radiation-induced movement disorders and the radiation techniques involved. In addition, the case of a patient developing camptocormia 23 years after radiation therapy of a non-Hodgkin’s lymphoma of the abdomen is described.
Results
In total, nine case series of radiation-induced DHS (n = 45 patients) and—including our case—three case reports (n = 3 patients) about radiogenic camptocormia were retrieved. Most cases (40/45 patients) occurred less than 15 years after radiotherapy involving extended fields for Hodgkin’s disease.
Conclusion
The use of wide radiation fields including many spinal segments with paraspinal muscles may lead to radiation-induced movement disorders. If paraspinal muscles and the thoracolumbar spine are involved, the clinical presentation can be that of camptocormia. DHS may result if there is involvement of the cervical spine. To prevent these disorders, sparing of the spine and paraspinal muscles is desirable.
Zusammenfassung
Hintergrund
In den letzten Jahren haben Bewegungsstörungen von Wirbelsäule und paraspinaler Muskulatur in Form von „Kamptokormie“ und „Dropped Head Syndrom“ (DHS) verstärkt wissenschaftliche Beachtung gefunden. Die Kamptokormie ist durch zunehmende Flexion des Oberkörpers beim Gehen bei wenig beeinträchtigtem aufrechtem Stand charakterisiert. Das DHS imponiert durch eine Schwäche der Nackenmuskulatur, die zu erschwerter Kopfhebung führt. In schweren Fällen ist bei der Kamptokormie das Gehen stark beeinträchtigt und beim DHS das Kinn auf der Brust nahezu fixiert. Viele Erkrankungen können eine Kamptokormie verursachen, insbesondere neuromuskuläre Erkrankungen und Basalganglienerkrankungen (z. B. Morbus Parkinson). Zudem sind in der Literatur Berichte über strahleninduzierte Kamptokormie und DHS vorhanden.
Methoden
In einer systematischen Recherche in PubMed mit den Begriffen „camptocormia“, „dropped head syndrome“, „radiation-induced movment disorder“, „radiation-induced myopathy“, „radiation-induced neuropathy“ wurden alle Publikationen zu diesen Themen erfasst und mit dem Ziel analysiert, strahleninduzierte Bewegungsstörungen und die verwendeten Bestrahlungstechniken näher zu charakterisieren. Zudem beschreiben wir den Fall eines Patienten, der 23 Jahre nach Bestrahlung eines Non-Hodgkin-Lymphoms des Abdomens eine erhebliche, schmerzhafte Kamptokormie entwickelte.
Ergebnisse
Es wurden 9 Fallberichte zu radiogenem DHS (n = 45 Patienten) und 3 Fallberichte (n = 3 Patienten) zu radiogener Kamptokormie gefunden. Die überwiegende Anzahl der beschriebenen Fälle (40/45 Patienten) trat > 15 Jahre nach Bestrahlung auf, überwiegend von Hodgkin-Lymphomen mit ausgedehnten Bestrahlungsfeldern.
Schlussfolgerung
Der Einsatz ausgedehnter Bestrahlungsfelder unter multisegmentalem Einschluss von Wirbelsäule und paraspinaler Muskulatur kann zum Auftreten von DHS nach Bestrahlung der Nackenmuskulatur und zu Kamptokormie nach Bestrahlung der Rückenstrecker führen. Zur Prävention dieser Komplikationen erscheint eine Schonung der jeweiligen Muskulatur ratsam.
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C. Seidel, T. Kuhnt, R-D. Kortmann, and K. Hering state that there are no conflicts of interest.
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Seidel, C., Kuhnt, T., Kortmann, RD. et al. Radiation-induced camptocormia and dropped head syndrome. Strahlenther Onkol 191, 765–770 (2015). https://doi.org/10.1007/s00066-015-0857-8
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DOI: https://doi.org/10.1007/s00066-015-0857-8
Keywords
- Camptocormia
- Dropped head syndrome
- Radiation-induced myopathy
- Radiation-induced neuropathy
- Radiation-induced movement disorder