In cases of functional spasm of the neck, Charcot[195] was wont to extol the combined use of electricity and massage, citing instances of a very protracted and aggravated nature where relief or even cure followed the application of the induced current to the muscles not involved in the spasm.
A case in point was a man who entered the Salpêtrière in 1888 with clonic spasm of the sternomastoid and trapezius, originating in depression caused by financial losses. The symptoms were not unlike what has been described more recently as mental torticollis. The condition had resisted all treatment during nine months, but vanished with singular rapidity after a few applications of the battery, during which the unaffected sternomastoid was faradised for fifteen minutes so as to produce the inverse of the pathological attitude.
Equally satisfactory results are frequently obtained in mental torticollis from the maintenance of the antagonistic position by the hand or campimeter, or simply by order given. It ought not to be forgotten, however, that Charcot himself was astonished at these unlooked-for successes, since he closes his lesson with the sceptical injunction not to hail the victory complete nor ignore in such histories the chapter of relapses.
Several of our own patients, similarly affected, have found electrotherapy an egregious failure. Most sufferers from tic have essayed it at one time or another, and if they do not accuse it of having intensified their symptoms, the memory they retain of it is usually anything but pleasant. All that is permissible in suitable cases is to employ electricity "in psychotherapeutic doses." Let the patient see the coil, or hear the interrupter, or feel the damp electrodes, and even though the current be infinitesimal, in the sequel the suggestion may prove efficacious. Generally speaking, however, such subterfuges ought to be avoided.
SUGGESTION
Hypnotic suggestion has sometimes given tangible results, but it is strictly applicable only to hysteria, which is, as we have seen, a comparatively rare accompaniment of tic.
Reference may be made to some cases of Raymond and Janet, where the method was successful in curing a constant giggle of four months' duration; hiccough also, and spasms of the limbs, were combated by these means.
One of the cases recorded by Welterstrand[196] was a child of ten years who had stammered ever since he could speak at all, and who in addition had for some time suffered from facial contortions—elevation of the eyelids and eyebrows, and twitching of the lips. Six séances sufficed to banish the symptoms, which at the end of several months had not recurred. Another of his patients was a young woman, twenty years old, with incessant spasmodic movements of mouth and eyebrows. The disfiguring grimaces of years disappeared completely by the tenth sitting.
Van Renterghem[197] has recorded a case of rotatory tic also cured by hypnotism. Feron[198] and Vlavianos[199] report similar successes, but one may legitimately ask whether the phenomena were not really hysterical manifestations, and if the results attained any degree of permanence. Treatment by suggestion is, as a general rule, ineffectual. In Maréchal's[200] case of mental torticollis with symptoms of two years' duration, recourse was made to this measure but without avail, and our experience has been identical.
Raymond and Janet[201] have noted favourable results by the adoption of suggestion during waking hours, without going the length of hypnotic sleep; in one case of tic simulating chorea, a cure followed the threat of surgical intervention.