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At a glance

Association of torsional dystonia, mainly involving the neck and upper extremities, with gastroesophageal reflux disease. During paroxysmal dystonic posture crisis, opisthotonos may be present.


Sandifer Complex.


Incidence is unknown, although there is some suggestion that it occurs in fewer than 1% of children with gastroesophageal reflux. Occurs mainly in neurologically healthy male children.

Clinical aspects

Torsional dystonia occurs shortly after feeding for 1 to 3 minutes (commonly mistaken for seizures). A relationship with feeding may suggest a diagnosis of Sandifer Syndrome.

Anesthetic considerations

No particular anesthetic consideration is known. However, the disorder should be known because of its possible confusion with seizures. Modified rapid sequence induction is recommended for these patients because of gastric reflux. Postoperative administration of antacid medication is useful.


Frankel  EA, Shalaby  TM, Orenstein  SR: Sandifer syndrome posturing: Relation to abdominal wall contractions, gastroesophageal reflux, and fundoplication. Dig Dis Sci 51:635, 2006.  [PubMed: 16614981]
Kirkham  FJ, Haywood  P, Kashyape  P,  et al: Movement disorder emergencies in childhood. Eur J Paediatr Neurol 15:390, 2011.  [PubMed: 21835657]
Puntis  JW, Smith  HL, Buick  RG,  et al: Effect of dystonic movements on oesophageal peristalsis in Sandifer’s syndrome. Arch Dis Child 64(9):1311, 1989.  [PubMed: 2817953]

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