Dystonic opisthotonus: A "red flag" for neurodegeneration with brain iron accumulation syndromes?

Maria Stamelou, Scarlett C. Lai, Annu Aggarwal, Susanne A. Schneider, Henry Houlden, Tu Hsueh Yeh, Amit Batla, Chin Song Lu, Mohit Bhatt, Kailash P. Bhatia

Research output: Contribution to journalArticlepeer-review

35 Citations (Scopus)


Back arching was reported in one of the very first patients with neurodegeneration with brain iron accumulation syndrome (NBIAs) published in 1936. However, recent reports have mainly focused on the genetic and imaging aspects of these disorders, and the phenotypic characterization of the dystonia has been lost. In evaluating patients with NBIAs in our centers, we have observed that action-induced dystonic opisthotonus is a common and characteristic feature of NBIAs. Here, we present a case series of patients with NBIAs presenting this feature demonstrated by videos. We suggest that dystonic opisthotonus could be a useful "red flag" for clinicians to suspect NBIAs, and we discuss the differential diagnosis of this feature. This would be particularly useful in identifying patients with NBIAs and no iron accumulation as yet on brain imaging (for example, as in phospholipase A2, group IV (cytosolic, calcium-independent) [PLA2G6]-related disorders), and it has management implications.

Original languageEnglish
Pages (from-to)1325-1329
Number of pages5
JournalMovement Disorders
Issue number10
Publication statusPublished - Sept 2013
Externally publishedYes


  • Extensor axial dystonia
  • NBIA
  • Neurodegeneration with brain iron accumulation
  • Opisthotonus
  • PANK2
  • PLA2G6
  • Retrocollis

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology


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