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Rotatory “Head on Bed” Alleviates Pantothenate Kinase-Associated Neurodegeneration -
Farsana Mustafa
, Divyani Garg
, Abhishek Mudda, Sreeja Samineni, Ayush Agarwal, Achal Kumar Srivastava -
Journal of Movement Disorders 2026;19(1):117-118.
DOI: https://doi.org/10.14802/jmd.25200
Published online: July 30, 2025
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
- Corresponding author: Divyani Garg, DM Department of Neurology, All India Institute of Medical Sciences, Room 705, CN Centre, New Delhi 110029, India / Tel: +91-11-2659-4317 / E-mail: divyanig@gmail.com
• Received: July 25, 2025 • Revised: July 29, 2025 • Accepted: July 30, 2025
Copyright © 2026 The Korean Movement Disorder Society
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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An 18-year-old girl presented with a 6-month history of progressive posturing of the neck, trunk and limbs. Examination revealed severe right laterocollis and truncal dystonia, limb dystonia and dystonic tremors. She was found to execute an unusual alleviating maneuver (AM) to reduce cervical and truncal posturing that involved bending her trunk forward while seated, placing the head on the bed, and rotating her entire body clockwise in the direction of cervical and truncal dystonia (Supplementary Video 1 in the online-only Data Supplement), which led to a reduction in neck pain with a moderate reduction in cervical and truncal dystonia. MRI of the brain revealed a T2-hypointense globus pallidi with anteromedial hyperintensities, which was consistent with the “eye of tiger” sign (Figure 1). Whole-exome sequencing revealed compound heterozygous variants in the PANK2 gene (c.1102A>G; p.Lys368.Glu on exon 5/c.425T>G; p.Leu142Arg on exon 2). Although AMs are considered typical of primary dystonia [1], they may be associated with secondary dystonia, such as tardive dystonia and pantothenate kinase-associated neurodegeneration (PKAN) [2,3]. While the “mantis” sign in PKAN is an AM associated with jaw-opening dystonia [2], rotatory “head on bed” AM has not been previously reported.
Supplementary Materials
The online-only Data Supplement is available with this article at https://doi.org/10.14802/jmd.25200.
Video 1.
“Head on bed” alleviating maneuver. Segment A (patient seated in a chair) shows severe right laterocollis and rightward truncal bending. She has upper limb dystonia with dystonic tremors and lower limb dystonia. The lower limb dystonia is well appreciated upon walking. Segment B: When seated on the bed, the patient assumed forward bending of the trunk, placing her head on the bed, followed by clockwise rotation of her entire body.
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Ethics Statement
The authors obtained written consent from the patient.
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Conflicts of Interest
The authors have no financial conflicts of interest.
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Funding Statement
None
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Acknowledgments
None
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Author Contributions
Conceptualization: Divyani Garg. Data curation: Farsana Mustafa, Abhishek Mudda, Sreeja Samineni. Investigation: Farsana Mustafa, Abhishek Mudda, Sreeja Samineni. Methodology: Divyani Garg. Resources: Ayush Agarwal, Achal Kumar Srivastava. Supervision: Divyani Garg. Validation: Divyani Garg. Writing—original draft: Farsana Mustafa. Writing—review and editing: Abhishek Mudda, Sreeja Samineni, Ayush Agarwal, Divyani Garg, Achal Kumar Srivastava.
Notes
Figure 1.
MRI of the brain. T2-weighted axial image showing symmetrical hypointensity of the bilateral globus pallidi with hyperintense signal changes in the anteromedial region, which is consistent with the “eye of tiger” sign. MRI, magnetic resonance imaging.
- 1. Patel N, Hanfelt J, Marsh L, Jankovic J; members of the Dystonia Coalition. Alleviating manoeuvres (sensory tricks) in cervical dystonia. J Neurol Neurosurg Psychiatry 2014;85:882–884.ArticlePubMedPMC
- 2. Martins J, Darling A, Garrido C, Espinós C, Martí MJ, Dueñas BP, et al. Sensory tricks in pantothenate kinase-associated neurodegeneration: video-analysis of 43 patients. Mov Disord Clin Pract 2019;6:704–707.ArticlePubMedPMCPDF
- 3. Petrović IN, Kresojević N, Ganos C, Svetel M, Dragašević N, Bhatia KP, et al. Characteristic “forcible” geste antagoniste in oromandibular dystonia resulting from pantothenate kinase-sssociated neurodegeneration. Mov Disord Clin Pract 2014;1:112–114.ArticlePubMedPMC
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XML DownloadRotatory “Head on Bed” Alleviates Pantothenate Kinase-Associated Neurodegeneration
Figure 1. MRI of the brain. T2-weighted axial image showing symmetrical hypointensity of the bilateral globus pallidi with hyperintense signal changes in the anteromedial region, which is consistent with the “eye of tiger” sign. MRI, magnetic resonance imaging.
Figure 1.
Rotatory “Head on Bed” Alleviates Pantothenate Kinase-Associated Neurodegeneration
