To the Editor.—In answer to Dr. Raab's question, the eyes of all 12 patients were, of course, examined by me. Fundi were normal and no muscle imbalance could be detected. Four of the children were referred to an ophthalmologist, who also failed to find refractive errors or muscle imbalance to account for the head tilting.
I agree with Dr. Raab that ocular motor imbalance may cause head tilting of a nonparoxysmal nature, whereas all of these children suffered clear-cut sudden paroxysms of torticollis or head tilting.
Since publication of my report, I have studied five more similar cases, bringing the total to 17. The most recent, a baby of 6 months, had definite horizontal nystagmus during, but not between, attacks of head tilting.
Many letters received since publication of my report confirm the fact that this condition is not rare and has puzzled many pediatricians in the past. I continue