Botulinum toxin treatment of dystonic anterocollis: What to inject
| Autor: | Lucy A. Hicklin, Marie-Helene Marion |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Adult Male Botulinum Toxins 03 medical and health sciences 0302 clinical medicine Longus Colli Cervical muscle weakness Neck Muscles Medicine Humans Cervical dystonia Prospective Studies Torticollis Aged business.industry Parkinsonism Meige Syndrome Middle Aged medicine.disease Botulinum toxin Sagittal plane 030104 developmental biology medicine.anatomical_structure Neurology Neuromuscular Agents Anesthesia Neck flexion Female Neurology (clinical) Geriatrics and Gerontology business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Parkinsonismrelated disorders. 88 |
| ISSN: | 1873-5126 |
| Popis: | Background Anterocollis (AC) is a rare form of cervical dystonia, which responds poorly to botulinum toxin treatment. Objectives To recognise the different clinical phenotypes of AC and to detail the selection of muscles from the results of treating a cohort of 15 AC patients with Botulinum Toxin. Methods The study was performed using prospectively collected data. We included 15 patients with cervical dystonia and AC posture, treated between 2016 and 2019 in our joint Neuro-ENT clinic. We excluded patients with posterior cervical muscle weakness and patients with Parkinsonism. We characterised the primary dystonic posture of every AC patient as posterior sagittal shift, head flexion or neck flexion, or a combination of the three. Results All AC patients had a more widespread dystonic picture with a majority having Meige syndrome, but AC was the most problematic feature. Treatment with botulinum toxin required the injection not only of the deep cervical flexor (DCF), but also the sterno-cleido-mastoid (SCM) and moreover the supra-hyoid (SH) muscles. The choice between the longus capiti and the longus colli depended on the AC posture. Half of the patients had a dramatic improvement with 90% satisfaction or above. Conclusion AC posture is a complex but treatable type of CD. A joint Neuro-ENT clinic is an ideal setting in which to target all the dystonic muscles. This allows the injection of the longus capiti (under nasal endoscopic approach) as well as the supra-hyoid and SCM muscles in the same session. |
| Databáze: | OpenAIRE |
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