Sandifer syndrome

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Sandifer's syndrome

Overview

Sandifer syndrome is a pediatric medical disorder, characterized by gastrointestinal symptoms and associated neurological features. There is a significant correlation between the syndrome and gastro-esophageal reflux disease (GERD); however, it is estimated to occur in less than 1% of children with reflux. Diagnosis is made on the basis of the association of gastro-esophageal reflux with the characteristic movement disorder. Early diagnosis is critical, as treatment is simple and leads to prompt resolution of the movement disorder.

Differential Diagnosis

• Benign infantile spasms
• Epileptic seizures

Natural History, Complications and Prognosis

Onset is usually confined to infancy and early childhood, with peak prevalence at 18–36 months. In rare cases, particularly where the child is severely mentally impaired, onset may extend to adolescence.

Spasms may last for 1–3 minutes and may occur up to 10 times a day. Ingestion of food is often associated with occurrence of symptoms; this may result in reluctance to feed. Associated symptoms, such as epigastric discomfort, vomiting (which may involve blood) and abnormal eye movements have been reported. Clinical signs may also include anemia.

Sandifer syndrome is not typically life-threatening and the prognosis is typically good.

Diagnosis

Symptoms

• Spasmodic torticollis
• Dystonia
• Nodding and rotation of the head
• Neck extension
• Gurgling
• Writhing movements of the limbs
• Severe hypotonia

Physical Examination

Neurological examination is usually normal.

Treatment

Successful treatment of the associated underlying disorder, such as GERD or hiatal hernia, may provide relief.