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Opisthotonus: Revisiting a classic movement disorder
José Fidel Baizabal-Carvallo1, Joseph Jankovic2
1Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA.; Department of Sciences and Engineering, University of Guanajuato; León, Mexico..
Journal of the Neurological Sciences
|February 2, 2026
Summary
Opisthotonus, a condition of backward trunk arching, is most commonly caused by functional movement disorders. Identifying the specific cause is crucial for effective treatment strategies.
Area of Science:
- Neurology
- Movement Disorders
- Clinical Medicine
Background:
- Opisthotonus involves involuntary extensor muscle contractions causing backward trunk arching.
- Known causes include tetanus, intoxication, dystonia, seizures, and functional movement disorders.
- Congenital causes like inborn errors of metabolism and epileptic encephalopathies are critical in infants.
Purpose of the Study:
- To determine the prevalence and etiological spectrum of opisthotonus in a tertiary movement disorder center.
- To highlight the significance of accurate diagnosis for guiding treatment.
Main Methods:
- A retrospective survey of 1216 patients evaluated for movement disorders.
- Identification and classification of patients presenting with opisthotonus.
Main Results:
- Opisthotonus was identified in 17 (1.4%) patients.
- Functional opisthotonus was the most frequent cause (9 patients, 53%).
- Other causes included tardive dystonia, basal ganglia cavernoma, hypoxic encephalopathy, and idiopathic dystonia.
Conclusions:
- Functional movement disorders are the leading cause of opisthotonus in this cohort.
- Accurate etiological diagnosis is essential for appropriate therapeutic interventions.
- Pharmacological and surgical options exist, tailored to the underlying cause.
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