Feed-induced Dystonias in Children With Severe Central Nervous System Disorders.
Dystonias can arise from any painful stimuli in neurologically disabled children. Classically, feed-induced dystonias from mediastinal pain due to severe gastroesophageal reflux disease are described as Sandifer spasm. We report a case series of 12 severely neurologically impaired children with enteral feed-induced dystonias. Intestinal dysmotility was demonstrated in several. Improvements are seen with jejunal feeds or gut rest with total parenteral nutrition. Use of parenteral nutrition in children with severe neurodisability requires thorough discussion with patient groups and commissioners to give clinicians guidelines to standardize care.
*Department of Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, South Yorkshire †Department of Paediatrics, Hull Royal Infirmary, Hull ‡Department of Gastroenterology, University of Sheffield, Western Bank, Sheffield, UK.
Santosh R
SR
Mordekar
Manjula
M
Velayudhan
David I
DI
Campbell
D000293:Adolescent; D002493:Central Nervous System Diseases / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004421:Dystonia / Q000175:diagnosis / Q000209:etiology*; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology; D005769:Gastrointestinal Motility; D006801:Humans; D007223:Infant; D008297:Male; D010288:Parenteral Nutrition; D012189:Retrospective Studies