|
1
|
Aradi S, Hauser RA. Current use of neurotoxins for alleviating symptoms of cervical dystonia. Expert Rev Neurother 2024; 24:787-797. [PMID: 39049547 DOI: 10.1080/14737175.2024.2368638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/12/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Cervical dystonia (CD) causes involuntary movements and postures of the head, neck, and shoulders, as well as nonmotor symptoms including pain, mood, and sleep dysfunction, and impacts quality of life. The first-line treatment for CD is botulinum neurotoxin (BoNT) injections. AREAS COVERED The clinical presentation and diagnosis of CD, as well as where BoNT resides in the treatment landscape, is reviewed first. Next, the mechanism of action and the pharmacological differences in the available preparations of BoNT products are explained. The evidence base for motor and nonmotor efficacy and safety of the available BoNT formulations is reviewed, with attention to duration of benefit as a driver of patient satisfaction. Practical determinants of BoNT efficacy are reviewed including muscle selection, accurate muscle injection, factors related to poor or deteriorating response, and immunogenicity. EXPERT OPINION BoNT represents a significant advancement in the treatment of CD. More accurate diagnosis, muscle selection and targeting, and dosing can improve outcomes with existing BoNT formulations. Further refinement of BoNT potency, duration of action, safety, and immunogenicity will help reduce unmet needs in the magnitude and duration of benefit. Additional validation of DBS and MRI-guided focused ultrasound may expand options for patients with toxin nonresponse.
Collapse
Affiliation(s)
- Stephen Aradi
- Department of Neurology, Parkinson's Foundation Center of Excellence, University of South Florida, TampaFLUSA
| | - Robert A Hauser
- Department of Neurology, Parkinson's Foundation Center of Excellence, University of South Florida, TampaFLUSA
| |
Collapse
|
|
2
|
Bleton JP, Portero R, Zuber K, Sangla S, Brandel JP, Vidailhet M, Mesure S, Williams M, Savatovsky J. Assessment of axial rotation movement in cervical dystonia using cone-beam computed tomography. Clin Biomech (Bristol, Avon) 2023; 107:106037. [PMID: 37429102 DOI: 10.1016/j.clinbiomech.2023.106037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Cervical dystonia is a neurological disorder characterized by involuntary muscle contractions and abnormal postures of the head and neck. Botulinum neurotoxin injection is the first-line treatment. Imaging determination of the cervical segments involved (lower or upper according to the torticollis-torticaput [COL-CAP] Classification) is an aid in determining the muscles to be injected. We aimed to clarify the impact of dystonia on posture and rotational movement of cervical vertebrae in the transverse plane. METHODS A comparative study was conducted in a movement disorders department. Ten people with cervical dystonia and 10 matched healthy subjects (without cervical dystonia) were recruited. 3-D images of posture and cervical range of motion in axial rotation in the sitting position were recorded by using a cone-beam CT scanner. Range of rotational motion of the upper cervical spine from the occipital bone to fourth cervical vertebra was measured and compared between the two groups. FINDINGS The head posture analysis showed that the total cervical spine position was more significantly distant from the neutral position for people with dystonia than healthy subjects (p = 0.007). The rotational range of motion of the cervical spine was significantly lower in cervical dystonia participants than in healthy subjects for the total (p = 0.026) and for upper cervical spine (p = 0.004). INTERPRETATION We demonstrated, by means of cone-beam CT, that the disorganization of movements due to cervical dystonia affected the upper cervical spine and mostly the atlantoaxial joint. The involvement of rotator muscles at this cervical level should be considered more in treatments.
Collapse
Affiliation(s)
- Jean-Pierre Bleton
- Neurology Department, Hôpital Fondation Adolphe de Rothschild, Paris, France; Clinical Research Department, Hôpital Fondation Adolphe de Rothschild, Paris, France.
| | - Raphaël Portero
- Clinical Research Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Kévin Zuber
- Clinical Research Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Sophie Sangla
- Neurology Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | | | - Marie Vidailhet
- Sorbonne Université, F-75005 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'Hôpital, F-75013 Paris, France; Inserm U1127, CNRS UMR 7225, UM 75, ICM, F-75013 Paris, France
| | - Serge Mesure
- Aix-Marseille University, CNRS, ISM UMR 7287, F-13288 Marseille, France
| | - Marc Williams
- Department of Radiology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Julien Savatovsky
- Department of Radiology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| |
Collapse
|
|
3
|
Gelisin O, Susgun S, Toruntay C, Yabaci A, Baran G, Gursoy AEB, Yildiz GB, Yucesan E. Evaluation of miR-526b-3p, miR-1179, miR-3529-3p, miR-5011-5p as potential diagnostic biomarkers in isolated cervical dystonia. Rev Neurol (Paris) 2023:S0035-3787(23)00753-1. [PMID: 36759300 DOI: 10.1016/j.neurol.2022.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 10/20/2022] [Accepted: 10/23/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND Cervical dystonia (CD) also named spasmodic torticollis is the most common type of focal dystonias and characterized by abnormal head, neck, and shoulder movements due to involuntary muscular spasm. Although CD is mostly idiopathic, to date, several genes have been associated with CD. However, to the best of our knowledge, microRNAs (miRNAs) which are interacted with CD-associated genes have been not evaluated yet. miRNAs are regulatory small non-coding RNAs and are suggested as potential biomarkers for many diseases through their stability in clinical samples. Therefore, we aimed to assess the expression levels of miRNAs (miR-526b-3p, miR-1179, miR-3529-3p, miR-5011-5p) which are targeted the CD-associated genes, and evaluate their performance as diagnostic biomarkers. METHODS Peripheral blood samples were obtained from 30 patients with isolated CD (ICD) and 25 healthy controls. The expression levels of miR-526b-3p, miR-1179, miR-3529-3p, and miR-5011-5p were analyzed via quantitative real-time PCR (qRT-PCR), and receiver operating characteristic (ROC) curves were generated to evaluate the diagnostic values. RESULTS miR-526b-3p, miR-1179, and miR-3529-3p were significantly up-regulated while miR-5011-5p was significantly down-regulated in ICD patients compared to healthy controls. ROC analysis revealed that all miRNAs, especially miR-1179 and miR-3529-3p were statistically significant with the area under the curve (AUC) of 0.905 and 0.933, respectively. CONCLUSION Altered expression levels of aforementioned miRNAs may be associated with CD pathogenesis. Our findings suggest using these four miRNAs as remarkable biomarkers in the diagnosis of ICD.
Collapse
Affiliation(s)
- O Gelisin
- Department of Neurology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - S Susgun
- Department of Genetics, Istanbul University, Aziz Sancar Institute of Experimental Research, Istanbul, Turkey; Institute of Graduate Studies in Health Sciences, Istanbul University, Istanbul, Turkey
| | - C Toruntay
- Department of Molecular Biology and Genetics, Yildiz Technical University, Graduate School of Science and Engineering, Istanbul, Turkey
| | - A Yabaci
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - G Baran
- Department of Neurology, Marmara University, Pendik Training and Research Hospital, Istanbul, Turkey
| | - A E B Gursoy
- Department of Neurology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - G B Yildiz
- Department of Neurology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - E Yucesan
- Department of Neurogenetics, Institute of Neurological Sciences , Istanbul University-Cerrahpasa, Istanbul, Turkey.
| |
Collapse
|
|
4
|
Santifort KM, Mandigers PJJ. Dystonia in veterinary neurology. J Vet Intern Med 2022; 36:1872-1881. [PMID: 36086931 DOI: 10.1111/jvim.16532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/22/2022] [Indexed: 11/27/2022] Open
Abstract
Dystonia is a clinical sign and main feature of many movement disorders in humans as well as veterinary species. It is characterized by sustained or intermittent involuntary muscle contractions causing abnormal (often repetitive) movements, postures, or both. This review discusses the terminology and definition of dystonia, its phenomenology, and its pathophysiology, and provides considerations regarding the diagnosis and treatment of dystonia in dogs and cats. In addition, currently recognized or reported disorders in dogs and cats in which dystonia is a particular or main feature are discussed and comparisons are made between disorders featuring dystonia in humans and animals. We suggest that when describing the phenomenology of dogs and cats with dystonia, if possible the following should be included: activity being performed at onset (e.g., resting or running or exercise-induced), body distribution, duration, responsiveness (subjective), severity, temporal pattern (i.e., paroxysmal or persistent, severity at onset and at later stages), presence or absence of autonomic signs (e.g., salivation), presence or absence of preceding signs (e.g., restlessness), presence or absence of signs after dystonia subsides (e.g., sleepiness), coexistence of other movement disorders, any other neurological manifestations, and possible links to administered medications, intoxications or other associated factors. We also suggest that dystonia be classified based on its etiology as either structural genetic, suspected genetic, reactive, or unknown.
Collapse
Affiliation(s)
| | - Paul J J Mandigers
- Evidensia Referral Hospitals, Arnhem, The Netherlands.,Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
|
5
|
Watson NA, Siddiqui Z, Miller BJ, Karagama Y, Gibbins N. Non-aesthetic uses of botulinum toxin in the head and neck. Eur Arch Otorhinolaryngol 2021; 278:4147-4154. [PMID: 33738565 DOI: 10.1007/s00405-021-06750-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/11/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The use of botulinum toxin in the specialty of aesthetic surgery in the head and neck is well known. However, it has also been used for other conditions affecting the head and neck, and in recent years its use, as well as the number of relevant applications, has expanded enormously. REVIEW This article presents a summary of the current range of uses in the laryngeal, pharyngeal, cervical, oromandibular and facial muscles and salivary glands. We highlight particular conditions focusing on dystonia (laryngeal, craniocervical, oromandibular and cervical), multiple system atrophy, migraines, facial nerve palsy, post-laryngectomy, cricopharyngeal dysphagia, Zenker's diverticulum, retrograde cricopharyngeal dysfunction disorder, sialorrhea and gustatory sweating (Frey's syndrome). CONCLUSION This article should aid the ear, nose and throat surgeon garner knowledge about the range of uses for botulinum toxin in the head and neck.
Collapse
Affiliation(s)
- Natalie Anne Watson
- Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Zohaib Siddiqui
- Department of Otolaryngology, Lewisham and Greenwich NHS Trust, Lewisham High Street, London, SE13 6LH, UK
| | - Benjamin John Miller
- Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Yakubu Karagama
- Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nicholas Gibbins
- Department of Otolaryngology, Lewisham and Greenwich NHS Trust, Lewisham High Street, London, SE13 6LH, UK
| |
Collapse
|
|
6
|
Watson NA, Miller BJ, Siddiqui Z, Karagama Y, Gibbins N. The Therapeutic Use of Botulinum Toxin Injections for Conditions Affecting the Head and Neck. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00305-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
|
7
|
Dressler D, Adib Saberi F, Rosales RL. Botulinum toxin therapy of dystonia. J Neural Transm (Vienna) 2020; 128:531-537. [PMID: 33125571 PMCID: PMC8099791 DOI: 10.1007/s00702-020-02266-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/09/2020] [Indexed: 01/13/2023]
Abstract
Botulinum toxin (BT) is used to treat a large number of muscle hyperactivity syndromes. Its use in dystonia, however, is still one of the most important indications for BT therapy. When BT is injected into dystonic muscles, it produces a peripheral paresis which is localised, well controllable and follows a distinct and predictable time course of around 3 months. Adverse effects are always transient and usually mild, long-term application is safe. With this profile BT can be used to treat cranial dystonia, cervical dystonia and limb dystonia including writer's and musician's cramps. The recent introduction of BT high dose therapy also allows to treat more wide-spread dystonia including segmental and generalised dystonia. BT can easily be combined with other anti-dystonic treatments such as deep brain stimulation and intrathecal baclofen application. Best treatment results are obtained when BT therapy is integrated in the multimodal and long-term 'multilayer concept of treatment of dystonia'. The biggest challenge for the future will be to deliver state of the art BT therapy to all dystonia patients in need, regardless of whether they live in developed countries or beyond.
Collapse
Affiliation(s)
- Dirk Dressler
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Fereshte Adib Saberi
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Raymond L Rosales
- Department of Neurology and Psychiatry, Neuroscience Institute, University of Santo Tomas Hospital, Manila, Philippines
| |
Collapse
|
|
8
|
Chen S, Issa MD, Wang C, Feng L, Teng F, Li B, Pan Y, Zhang X, Xu Y, Zhang Z, Su J, Ma H, Jin L. [ 99mTc]MIBI SPECT/CT for Identifying Dystonic Muscles in Patients with Primary Cervical Dystonia. Mol Imaging Biol 2019; 22:1054-1061. [PMID: 31721006 DOI: 10.1007/s11307-019-01436-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE This study aimed to evaluate the usefulness of [99mTc]sestamibi ([99mTc]MIBI) single photon emission computed tomography (SPECT)/X-ray computed tomography (CT) imaging for the identification of dystonic muscles in primary cervical dystonia (PCD) patients who underwent botulinum neurotoxin type A (BoNT-A) therapy. PROCEDURES Thirty-six patients with PCD and 10 healthy subjects (control group) who underwent [99mTc]MIBI SPECT/CT were enrolled. The image characteristics of dystonic muscles and normal muscles were evaluated. Muscle/background ratio (MBR) of six representative muscles was calculated for dystonic muscles in PCD group and normal muscles in control group. In PCD patients, target muscles injected with BoNT-A were selected by clinical evaluations and the results of needle electromyography (EMG) were considered as the gold standard. The sensitivity, specificity, and diagnostic efficacy of SPECT/CT were obtained from the receiver operator characteristic (ROC) curve. RESULTS Twenty-four PCD patients were included in our study eventually, because three PCD patients whose follow-up were lost and 9 PCD patients whose maximum reduction of Tsui scale scores was < 80 % were ruled out. Normal muscles of healthy subjects showed mild symmetrical radioactivity distribution, while in PCD patients, [99mTc]MIBI uptake in dystonic muscles abnormally increased. The mean MBRs of dystonic muscles were significantly higher than those of normal muscles. The sensitivity, specificity, and area under the curve (AUC) of SPECT/CT were 93.2 %, 88.5 %, and 0.908, respectively. CONCLUSIONS Our study indicated that [99mTc]MIBI SPECT/CT may be a useful method for identifying dystonic muscles and a guide to BoNT-A therapy in PCD patients.
Collapse
Affiliation(s)
- Shuzhen Chen
- Department of Nuclear Medicine, Tongji Hospital, Tongji University School of Medicine, No.389 Xincun Road, Putuo District, Shanghai, 200065, China
| | - Malam Djibo Issa
- Department of Neurology, Tongji Hospital, Tongji University School of Medicine, No.389 Xincun Road, Putuo District, Shanghai, 200065, China
| | - Chenghong Wang
- Department of Nuclear Medicine, Tongji Hospital, Tongji University School of Medicine, No.389 Xincun Road, Putuo District, Shanghai, 200065, China
| | - Liang Feng
- Department of Neurology, Tongji Hospital, Tongji University School of Medicine, No.389 Xincun Road, Putuo District, Shanghai, 200065, China
| | - Fei Teng
- Department of Neurology, Tongji Hospital, Tongji University School of Medicine, No.389 Xincun Road, Putuo District, Shanghai, 200065, China
| | - Bing Li
- Department of Neurology, Tongji Hospital, Tongji University School of Medicine, No.389 Xincun Road, Putuo District, Shanghai, 200065, China
| | - Yougui Pan
- Department of Neurology, Tongji Hospital, Tongji University School of Medicine, No.389 Xincun Road, Putuo District, Shanghai, 200065, China
| | - Xiaolong Zhang
- Department of Neurology, Tongji Hospital, Tongji University School of Medicine, No.389 Xincun Road, Putuo District, Shanghai, 200065, China
| | - Yifei Xu
- Department of Neurology, Tongji Hospital, Tongji University School of Medicine, No.389 Xincun Road, Putuo District, Shanghai, 200065, China
| | - Zhuoyu Zhang
- Department of Neurology, Tongji Hospital, Tongji University School of Medicine, No.389 Xincun Road, Putuo District, Shanghai, 200065, China
| | - Junhui Su
- Department of Neurology, Tongji Hospital, Tongji University School of Medicine, No.389 Xincun Road, Putuo District, Shanghai, 200065, China
| | - Hongxing Ma
- Department of Nuclear Medicine, Tongji Hospital, Tongji University School of Medicine, No.389 Xincun Road, Putuo District, Shanghai, 200065, China.
| | - Lingjing Jin
- Department of Neurology, Tongji Hospital, Tongji University School of Medicine, No.389 Xincun Road, Putuo District, Shanghai, 200065, China.
| |
Collapse
|
|
9
|
Author’s Response to Letter to the Editor on “Ultrasound-Guided Botulinum Toxin Injections in Cervical Dystonia Needs Prompt Muscle Selection, Appropriate Dosage, and Precise Guidance”. Am J Phys Med Rehabil 2019; 98:e21-e23. [DOI: 10.1097/phm.0000000000001014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
|
10
|
Sonographic Guide for Botulinum Toxin Injections of the Neck Muscles in Cervical Dystonia. Phys Med Rehabil Clin N Am 2018; 29:105-123. [PMID: 29173657 DOI: 10.1016/j.pmr.2017.08.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Intramuscular botulinum toxin (BoTX) injection is the first-line treatment of cervical dystonia. Poor treatment outcomes and some side effects, however, have been reported after BoTX applications. One of the most important reasons is incorrect localization of the needle during toxin injections. Without imaging, it is impossible to verify precise needle positioning in the proper muscle. Ultrasound has been recommended because of its high capability in illustrating most of the neck muscles. This review article discusses how ultrasound imaging can be used to scan/access neck muscles, mainly from the perspective of BoTX injections.
Collapse
|
|
11
|
Schramm A, Huber D, Möbius C, Münchau A, Kohl Z, Bäumer T. Involvement of obliquus capitis inferior muscle in dystonic head tremor. Parkinsonism Relat Disord 2017; 44:119-123. [PMID: 28802760 DOI: 10.1016/j.parkreldis.2017.07.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 07/20/2017] [Accepted: 07/31/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Head tremor is a common feature in cervical dystonia (CD) and often less responsive to botulinum neurotoxin (BoNT) treatment than dystonic posturing. Ultrasound allows accurate targeting of deeper neck muscles. METHODS In 35 CD patients with dystonic head tremor the depth and thickness of the splenius capitis (SPL), semispinalis capitis and obliquus capitis inferior muscles (OCI) were assessed using ultrasound. Ultrasound guided EMG recordings were performed from the SPL and OCI. RESULTS Burst-like tremor activity was present in both OCI in 25 and in one in 10 patients. In 18 patients, tremor activity was present in one SPL and in 2 in both SPL. Depth and thickness of OCI, SPL and semispinalis capitis muscles were very variable. CONCLUSION Muscular activity underlying tremulous CD is most commonly present in OCI. Due to the variability of muscle thickness, we suggest ultrasound guided BoNT injections into OCI.
Collapse
Affiliation(s)
- A Schramm
- Department of Neurology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - D Huber
- Department of Neurology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - C Möbius
- Department of Neurology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - A Münchau
- Institute of Neurogenetics, Center for Brain, Behavior and Metabolism (CBBM), Marie-Curie-Strasse 66, 23538 Lübeck, Germany
| | - Z Kohl
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - T Bäumer
- Institute of Neurogenetics, Center for Brain, Behavior and Metabolism (CBBM), Marie-Curie-Strasse 66, 23538 Lübeck, Germany.
| |
Collapse
|
|
12
|
Bentivoglio AR, Di Stasio E, Mulas D, Cerbarano ML, Ialongo T, Laurienzo A, Petracca M. Long-Term Abobotulinumtoxin A Treatment of Cervical Dystonia. Neurotox Res 2017; 32:291-300. [DOI: 10.1007/s12640-017-9737-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 04/13/2017] [Accepted: 04/20/2017] [Indexed: 12/17/2022]
|
|
13
|
De Bruijn E, Nijmeijer S, Forbes P, Koelman J, van der Helm F, Tijssen M, Happee R. Improved identification of dystonic cervical muscles via abnormal muscle activity during isometric contractions. J Neurol Sci 2015; 354:10-6. [DOI: 10.1016/j.jns.2015.03.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 02/11/2015] [Accepted: 03/30/2015] [Indexed: 11/16/2022]
|
|
14
|
Albanese A, Abbruzzese G, Dressler D, Duzynski W, Khatkova S, Marti MJ, Mir P, Montecucco C, Moro E, Pinter M, Relja M, Roze E, Skogseid IM, Timerbaeva S, Tzoulis C. Practical guidance for CD management involving treatment of botulinum toxin: a consensus statement. J Neurol 2015; 262:2201-13. [PMID: 25877834 PMCID: PMC4608989 DOI: 10.1007/s00415-015-7703-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 03/04/2015] [Accepted: 03/05/2015] [Indexed: 01/02/2023]
Abstract
Cervical dystonia is a neurological movement disorder causing abnormal posture of the head. It may be accompanied by involuntary movements which are sometimes tremulous. The condition has marked effects on patients’ self-image, and adversely affects quality of life, social relationships and employment. Botulinum neurotoxin (BoNT) is the treatment of choice for CD and its efficacy and safety have been extensively studied in clinical trials. However, current guidelines do not provide enough practical information for physicians who wish to use this valuable treatment in a real-life setting. In addition, patients and physicians may have different perceptions of what successful treatment outcomes should be. Consequently, an international group of expert neurologists, experienced in BoNT treatment, met to review the literature and pool their extensive clinical experience to give practical guidance about treatment of CD with BoNT. Eight topic headings were considered: the place of BoNT within CD treatment options; patient perspectives and desires for treatment; assessment and goal setting; starting treatment with BoNT-A; follow-up sessions; management of side effects; management of non-response; switching between different BoNT products. One rapporteur took responsibility for summarising the current literature for each topic, while the consensus statements were developed by the entire expert group. These statements are presented here along with a discussion of the background information.
Collapse
Affiliation(s)
- Alberto Albanese
- Neurologia I Istituto Neurologico Carlo Besta, Università Cattolica del Sacro Cuore, Via G. Celoria, 11, 20133, Milan, Italy.
| | - Giovanni Abbruzzese
- Centre for Parkinson's Disease and Movement Disorders DINOGMI, University of Genoa Largo Daneo 3, 16132, Genoa, Italy
| | - Dirk Dressler
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Wojciech Duzynski
- Section of Neurology, Department of Clinical Sciences, Lund University, Jan Waldenströms gata 15, 205 02, Malmö, Sweden
| | - Svetlana Khatkova
- Neurological Department for Post-Stroke Patients, Moscow Federal State Hospital for Treatment and Rehabilitation Ministry of Health Russia, Moscow, Russia
| | - Maria Jose Marti
- Neurology Service, Institut Cliníc de Neurosciències (ICN), CIBERNED, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Seville, Spain
| | - Cesare Montecucco
- Department of Biomedical Sciences, University of Padova, Via Ugo Bassi n. 58/B, 35121, Padua, Italy
| | - Elena Moro
- Division of Neurology, CHU of Grenoble, Joseph Fourier University, Grenoble, France
| | - Michaela Pinter
- Center for Neurorehabilitation, Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Maja Relja
- Referral Center for Movement Disorders, Department of Neurology, School of Medicine, University Hospital Center Zagreb, University of Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Emmanuel Roze
- AP-HP, Hôpital de la Pitié Salpêtrière, Département de Neurologie, 75013, Paris, France
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, 75013, Paris, France
| | - Inger Marie Skogseid
- Movement Disorders Unit, Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Sofiya Timerbaeva
- Department of Neurogenetics, Research Center of Neurology, Russian Academy of Medical Sciences, 80 Volokolamskoye shosse, Moscow, 125367, Russian Federation
| | - Charalampos Tzoulis
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
|
15
|
Nijmeijer S, de Bruijn E, Forbes P, Kamphuis D, Happee R, Koelman J, Tijssen M. EMG coherence and spectral analysis in cervical dystonia: Discriminative tools to identify dystonic muscles? J Neurol Sci 2014; 347:167-73. [DOI: 10.1016/j.jns.2014.09.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 09/09/2014] [Accepted: 09/22/2014] [Indexed: 12/19/2022]
|
|
16
|
Abstract
Oral medication, botulinum toxin injections, and deep brain stimulation are the current mainstays of treatment for dystonia. In addition, physical and other supportive therapies may help prevent further complications (eg, contractures) and improve function. This review discusses evidence-based medical treatment of dystonia with an emphasis on recent advances in treatment. We will also review the current treatment approaches and suggest ways in which these therapies can be applied to individuals with dystonia.
Collapse
Affiliation(s)
- D Cristopher Bragg
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | |
Collapse
|
|
17
|
Lee JR, Kiss ZHT. Interhemispheric difference of pallidal local field potential activity in cervical dystonia. J Neurol Neurosurg Psychiatry 2014; 85:306-10. [PMID: 23990682 DOI: 10.1136/jnnp-2013-305476] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Cervical dystonia (CD) produces involuntary neck muscle contractions that result in abnormal and often asymmetrical postures of the head and neck. Basal ganglia oscillatory activity in the 3-12 Hz band correlating with involuntary muscle activity suggests a role in the pathophysiology of primary dystonia. Despite the asymmetrical postures seen with CD, no comparison of interhemispheric differences of pallidal local field potential (LFP) activity has been reported. OBJECTIVE The aim of this study was to examine the interhemispheric differences of LFP power in globus pallidus interna (GPi) in CD patients and compare these with their predominant head excursion identified as torticollis, laterocollis and retrocollis. METHODS LFPs were recorded from bilateral GPi in 11 patients with CD using microelectrodes during deep brain stimulation surgery. LFP power was measured in right and left GPi separately. The mean percentage of total GPi LFP power in 4-30 Hz frequency band on each brain side was determined and related to their predominant CD symptoms. RESULTS Interhemispheric difference in the mean percentage of LFP power in 4-12 Hz and 13-30 Hz band frequencies was found in patients with torticollis and laterocollis regardless of excursion direction. However, patients with retrocollis did not show interhemispheric difference in LFP activity in any band frequency. CONCLUSIONS Interhemispheric differences in synchronisation of pallidal LFP activity in 4-12 Hz and 13-30 Hz bands are related to the CD clinical condition, suggesting that these frequencies are important in the pathophysiology of dystonia.
Collapse
Affiliation(s)
- Jung Ryun Lee
- Department of Clinical Neurosciences, Faculty of Medicine, Hotchkiss Brain Institute, University of Calgary, , Calgary, Alberta, Canada
| | | |
Collapse
|
|
18
|
Peña E. Treatment with botulinum toxin: An update. World J Neurol 2013; 3:29-41. [DOI: 10.5316/wjn.v3.i3.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 07/10/2013] [Accepted: 08/06/2013] [Indexed: 02/06/2023] Open
Abstract
Botulinum neurotoxin (BoNT) is a potent toxin produced by the anaerobic bacterium clostridium botulinum. It causes flaccid, long-lasting, local and reversible paralysis. In addition, BoNT inhibits the secretion of the exocrine glands and could have properties in the control of pain. Thus, BoNT is useful in the treatment of many neuromuscular conditions where an increase of muscle tone is associated with the pathogenic mechanism. Furthermore, BoNT is recommended in the treatment of some hypersecretion disorders of the exocrine gland and could play a role in the treatment of migraine and other chronic pain conditions. In the BoNT therapy adverse effects are usually mild and reversible. However, repeated injections of BoNT can lead to the development of neutralizing antibodies that can subsequently inhibit the biological activity of the toxin. In this sense, many factors can influence the immunogenicity of the BoNT, such as product-related factors, the dose of BoNT used, the frequency of injection and the previous exposure to the toxin. In this review, we are going to discuss the current clinical applications of BoNT with a special focus on evidence, doses, injection technique and adverse effects for those applications more frequently used in neurology, namely spasticity, blepharospasm, hemifacial spasm, cervical dystonia and other focal dystonias, as well as chronic migraine, tremor, sialorrhea, facial palsy, neurogenic bladder and many other neurological condition.
Collapse
|
|
19
|
Nijmeijer SWR, Koelman JHTM, Standaar TSM, Postma M, Tijssen MAJ. Cervical dystonia: improved treatment response to botulinum toxin after referral to a tertiary centre and the use of polymyography. Parkinsonism Relat Disord 2013; 19:533-8. [PMID: 23466060 DOI: 10.1016/j.parkreldis.2013.01.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 01/15/2013] [Accepted: 01/21/2013] [Indexed: 12/19/2022]
Abstract
RATIONALE Cervical dystonia is the most common form of (primary) dystonia. The first line of treatment for cervical dystonia is intramuscular injections with botulinum toxin. To optimise the response to botulinum toxin proper muscles selection is required. Pre-treatment polymyographic EMG in addition to clinical evaluation is hypothesised to be a good tool to improve muscle selection and treatment outcome. OBJECTIVE To determine the efficacy of botulinum toxin treatment after adjacent polymyographic EMG in cervical dystonia patients referred to our tertiary referral centre with an unsatisfactory response to botulinum toxin treatment elsewhere. METHODS We performed a retrospective analysis of 40 consecutive second opinion cervical dystonia patients. Standard polymyographic EMG was performed before treatment. We retrieved the Tsui scores and subjective evaluations from the first visit, after 12 weeks and after one year of treatment. In addition, we assessed the final outcome of treatment in our centre based on the records and asked the patients for their personal opinion about the effect of referral to our centre on their treatment response. RESULTS After one year of treatment there was a significant improvement on both the Tsui scores (p < 0.01) and the subjective treatment evaluation (p < 0.001.) On their last visit 60% of the patients still continued treatment with a reasonable to good response. CONCLUSION A substantial amount of CD patients with an unsatisfactory response to botulinum toxin improved after polymyography and subsequent treatment with botulinum toxin in a tertiary referral centre.
Collapse
Affiliation(s)
- S W R Nijmeijer
- Department of Neurology and Clinical Neurophysiology, Academic Medical Centre, Amsterdam, The Netherlands.
| | | | | | | | | |
Collapse
|
|
20
|
Lee HB, An YS, Lee HY, Hwang JH, Lee HJ, Jeong KY, Kim JW, Yim SY. Usefulness of (18)f-fluorodeoxyglucose positron emission tomography/computed tomography in management of cervical dystonia. Ann Rehabil Med 2012; 36:745-55. [PMID: 23342305 PMCID: PMC3546175 DOI: 10.5535/arm.2012.36.6.745] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 07/11/2012] [Indexed: 12/13/2022] Open
Abstract
Objective To evaluate the usefulness of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the management of cervical dystonia (CD) with botulinum toxin type A (BoNT-A) injection. Method Thirty two subjects with CD were included. A BoNT-A injection was provided either by clinically targeting method (group 1) or by 18F-FDG PET/CT-assisted, clinically targeting method (group 2). In group 2, selection of target muscles and dosage of BoNT-A were determined according to the increased 18F-FDG uptake, in addition to physical examination and functional anatomy. The outcomes of BoNT-A injection was compared between the two groups, in terms of the number of subjects who had reinjection before and after 6 months, the number of reinjections, the interval of reinjections, the duration to the minimal Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), the number of adverse events, the reduction rate of TWSTRS at 1-3 months and 3-6 months after injection, and the probability of reinjection-free living. Results The number of subjects who had reinjection within 6 months was significantly lower in group 2 than in group 1 (10 in group 1 vs. 3 in group 2). The reduction rate of TWSTRS after 3-6 months (37.8±15.7% of group 1 vs. 63.3±28.0% of group 2) and the probability of reinjection-free living were significantly higher in group 2 than in group 1. Conclusion These findings suggest that 18F-FDG PET/CT study could be useful in management of CD in terms of the identification of dystonic muscles if there is an increase in the 18F-FDG uptake in the cervical muscle of the images.
Collapse
Affiliation(s)
- Han Byul Lee
- The Center for Torticollis, Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon 443-749, Korea
| | | | | | | | | | | | | | | |
Collapse
|
|
21
|
Lim ECH, Quek AML, Seet RCS. Accurate targeting of botulinum toxin injections: how to and why. Parkinsonism Relat Disord 2012; 17 Suppl 1:S34-9. [PMID: 21999895 DOI: 10.1016/j.parkreldis.2011.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Botulinum toxin (BTX), the exotoxin of the obligate anaerobe, Clostridium botulinum, is used to ameliorate pain and treat conditions associated with glandular, smooth and skeletal muscle overactivity. The benefits derived from the injection of BTX may be negated by unintended weakness of uninjected muscles. Performance of BTX injections may be facile, requiring only surface marking or clinical-localisation techniques but may be more technically demanding, necessitating the use of equipment, such as electromyography (EMG) or ultrasonography (U/S). Less often, endoscopic, fluoroscopic or computed tomographic (CT) guidance may be required. Despite evidence to support the efficacy of BTX injections in treating many conditions, there is no evidence to support the superiority of any one injection technique over needle localisation using surface anatomy. This is possibly due to the lack of well-designed controlled studies, that is, current studies are hampered by small patient numbers, lack of consistency of injection technique and the application of different rating scales. Intuitively, certain injection techniques are more suited to injection of specific muscles or conditions, for example, U/S or passive-monitoring EMG should be used to treat cervical dystonia, active-monitoring EMG applied for strabismus injections, whereas either active-monitoring EMG or endoscopy is indicated when giving BTX for spasmodic dysphonia. Finally, electrical-stimulation EMG or U/S (or a combination of both) would be most suitable when injecting the forearm muscles for spasticity or writer's cramps.
Collapse
Affiliation(s)
- Erle C H Lim
- Division of Neurology, National University Hospital, National University Health System, National University of Singapore, Singapore.
| | | | | |
Collapse
|
|
22
|
Muscle selection for treatment of cervical dystonia with botulinum toxin--a systematic review. Parkinsonism Relat Disord 2012; 18:731-6. [PMID: 22575237 DOI: 10.1016/j.parkreldis.2012.04.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 03/30/2012] [Accepted: 04/04/2012] [Indexed: 12/19/2022]
Abstract
RATIONALE Cervical dystonia, also called spasmodic torticollis, is the most common form of (primary) dystonia. Intramuscular injections with botulinum toxin are the first line of treatment for cervical dystonia. To optimise the treatment response to botulinum toxin correct muscles should be selected. Clinical evaluation is important for muscle selection but the value of additional tests to identify dystonic muscles remains unclear. OBJECTIVE To evaluate all relevant literature regarding the best approach to select dystonic muscles for treatment with botulinum toxin. METHODS We conducted a systematic review of studies that had investigated methods of selecting muscles for treatment with botulinum toxin. In addition, we compared all prospective botulinum toxin trials using either clinical evaluation or polymyographic electromyography for muscle selection. RESULTS Forty relevant studies were included and polymyographic electromyography recordings were most often employed. In several studies, polymyographic electromyography revealed a different pattern of muscle involvement compared to that found during clinical evaluation. In one randomized controlled trial polymyographic electromyography significantly improved the outcome of botulinum toxin treatment. A limited number of studies used positron emission tomography -computed tomography imaging or frequency analysis of the electromyography signal to identify dystonic muscles but their effect on the outcome of treatment has never been studied. CONCLUSION Polymyographic electromyography may improve the outcome of botulinum toxin treatment in cervical dystonia, but evidence is limited and larger studies are needed.
Collapse
|
|
23
|
The utility of EMG interference pattern analysis in botulinum toxin treatment of torticollis: A randomised, controlled and blinded study. Clin Neurophysiol 2011; 122:2305-9. [DOI: 10.1016/j.clinph.2011.04.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 04/11/2011] [Accepted: 04/13/2011] [Indexed: 11/21/2022]
|
|
24
|
Bhidayasiri R. Treatment of complex cervical dystonia with botulinum toxin: Involvement of deep-cervical muscles may contribute to suboptimal responses. Parkinsonism Relat Disord 2011; 17 Suppl 1:S20-4. [DOI: 10.1016/j.parkreldis.2011.06.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
|
25
|
Abstract
Botulinum toxin (BT) is used in various medical specialties. However, dystonia is still one of the most important indications for BT therapy. BT drugs consist of botulinum neurotoxin, complexing proteins and excipients. Botox, Dysport and Xeomin are BT type A drugs and produce similar therapeutic and adverse effects (AE). Neurobloc/MyoBloc is based upon BT type B. Its use is limited by substantial systemic anticholinergic AE. The potency of BT drugs may be compared as follows: Botox:Xeomin:Dysport:Neuobloc/MyoBloc = 1:1:3:40. BT selectively blocks the cholinergic innervation of striate and smooth muscles and exocrine glands. It can produce obligate, local and systemic AE. However, its overall AE profile including long-term safety is excellent. BT can be blocked by antibodies. Risk factors include single doses, interinjection intervals and the immunological quality of the BT drug applied. Planning of BT therapy is based upon target muscle identification and estimation of their dystonic involvement. For planning of BT therapy and BT placement, electromyography and imaging techniques may be used additionally. So far, total Xeomin and Botox doses of up to 840 MU have been used without clinically detectable systemic AE. BT can be used to treat focal dystonias including cranial, pharyngolaryngeal, cervical and limb dystonias. In segmental and generalized dystonias, BT therapy has to be focussed on the most relevant target muscles. Combinations with all other treatment options including deep brain stimulation are possible. Recent safety data and availability of immunologically improved BT drugs are now allowing higher BT doses thus expanding the use of BT into more widespread dystonias.
Collapse
Affiliation(s)
- D Dressler
- Department of Neurology, Hannover Medical School, Hannover, Germany.
| |
Collapse
|
|
26
|
|
|
27
|
Jang SJ, Choi JY, Sung DH, Park KH, Lee JY, Cho SK, Yu J, Lee KH, Kim BT. Comparison between (18)F-FDG PET/CT and EMG Mapping for Identifying Dystonic Superficial Muscles in Primary Cervical Dystonia: Preliminary Results. Nucl Med Mol Imaging 2010; 44:33-8. [PMID: 24899935 DOI: 10.1007/s13139-009-0004-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 11/04/2009] [Accepted: 12/01/2009] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study was conducted to compare (18)F-FDG PET/CT and electromyography (EMG) mapping in patients with primary cervical dystonia (PCD) to find dystonic superficial cervical muscles. METHODS Ten consecutive patients with PCD (M:F = 5:5, age 44 ± 13 years) whose dystonic posture was not relieved with conventional muscle relaxant therapy were included. Target cervical muscles for the comparison between (18)F-FDG PET/CT and EMG mapping were four representative superficial bilateral cervical muscles: splenius capitis muscle, sternocleidomstoid muscle, upper trapezius muscle, and leavator scapulae muscle. The diagnostic efficacy was compared between (18)F-FDG PET/CT and EMG mapping using physical exam and measurement of rotation angle as the gold standard. RESULTS Among 80 muscles evaluated, there were 21 (26%) dystonic superficial cervical muscles assessed with physical exam and motion analysis. The sensitivity, specificity, and accuracy for localizing dystonic muscles were 76, 92, and 88% for (18)F-FDG PET/CT, and 95, 66, and 74% for EMG mapping, respectively. The sensitivity of EMG mapping was significantly higher than that of (18)F-FDG PET/CT. In contrast, (18)F-FDG PET/CT was significantly superior to EMG mapping for specificity and accuracy. CONCLUSIONS (18)F-FDG PET/CT is more specific and accurate than EMG mapping for finding superficial dystonic cervical muscles. The high sensitivity of EMG mapping suggests that (18)F-FDG PET/CT and EMG mapping are complementary for finding dystonic superficial cervical muscles.
Collapse
Affiliation(s)
- Su Jin Jang
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul National University School of Medicine, Seoul, Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkawn University School of Medicine, #50 Ilwon-dong, Gangnam-gu, Seoul, 135-710 Korea
| | - Duk Hyun Sung
- Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkawn University School of Medicine, Seoul, Korea
| | - Kwang Hong Park
- Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkawn University School of Medicine, Seoul, Korea
| | - Ji Young Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkawn University School of Medicine, #50 Ilwon-dong, Gangnam-gu, Seoul, 135-710 Korea
| | - Sook Kyung Cho
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkawn University School of Medicine, #50 Ilwon-dong, Gangnam-gu, Seoul, 135-710 Korea
| | - Jang Yu
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkawn University School of Medicine, #50 Ilwon-dong, Gangnam-gu, Seoul, 135-710 Korea
| | - Kyung-Han Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkawn University School of Medicine, #50 Ilwon-dong, Gangnam-gu, Seoul, 135-710 Korea
| | - Byung-Tae Kim
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkawn University School of Medicine, #50 Ilwon-dong, Gangnam-gu, Seoul, 135-710 Korea
| |
Collapse
|
|
28
|
The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy. Eur J Paediatr Neurol 2010; 14:45-66. [PMID: 19914110 DOI: 10.1016/j.ejpn.2009.09.005] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 09/15/2009] [Accepted: 09/17/2009] [Indexed: 12/20/2022]
Abstract
An interdisciplinary European group of clinical experts in the field of movement disorders and experienced Botulinum toxin users has updated the consensus for the use of Botulinum toxin in the treatment of children with cerebral palsy (CP). A problem-orientated approach was used focussing on both published and practice-based evidence. In part I of the consensus the authors have tabulated the supporting evidence to produce a concise but comprehensive information base, pooling data and experience from 36 institutions in 9 European countries which involves more than 10,000 patients and over 45,000 treatment sessions during a period of more than 280 treatment years. In part II of the consensus the Gross Motor Function Measure (GMFM) and Gross Motor Function Classification System (GMFCS) based Motor Development Curves have been expanded to provide a graphical framework on how to treat the motor disorders in children with CP. This graph is named "CP(Graph) Treatment Modalities - Gross Motor Function" and is intended to facilitate communication between parents, therapists and medical doctors concerning (1) achievable motor function, (2) realistic goal-setting and (3) treatment perspectives for children with CP. The updated European consensus 2009 summarises the current understanding regarding an integrated, multidisciplinary treatment approach using Botulinum toxin for the treatment of children with CP.
Collapse
|
|
29
|
Camargo CHF, Teive HAG, Becker N, Baran MHH, Scola RH, Werneck LC. Cervical dystonia: clinical and therapeutic features in 85 patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 66:15-21. [PMID: 18392407 DOI: 10.1590/s0004-282x2008000100005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Accepted: 12/22/2007] [Indexed: 11/21/2022]
Abstract
We studied patients with cervical dystonia (CD) to determine clinical features and response to botulinum toxin A (BoNT/A). Patients were submitted to clinical, laboratory and neuroimaging evaluation. BoNT/A was injected locally in 81 patients using electromyographic guidance. Four patients who had had previous treatment were considered to be in remission. The average ages at onset of focal dystonia and segmental dystonia were greater than for generalized dystonia (p<0.0003). The severity of the abnormal head-neck movements were more severe among the patients with generalized dystonia (p<0.001). Pain in the cervical area was noted in 59 patients. It was not possible to determine the etiology of the disease in 62.3% of patients. Tardive dystonia was the most common secondary etiology. A major improvement in the motor symptoms of CD and pain was observed in patients following treatment with BoNT/A. The tardive dystonia subgroup did not respond to the treatment. Dysphagia was observed in 2.35% of the patients.
Collapse
Affiliation(s)
- Carlos Henrique F Camargo
- Neurology Service, Department of Clinical Medicine, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | | | | | | | | | | |
Collapse
|
|
30
|
Lim ECH, Seet RCS. Botulinum toxin: description of injection techniques and examination of controversies surrounding toxin diffusion. Acta Neurol Scand 2008; 117:73-84. [PMID: 17850405 DOI: 10.1111/j.1600-0404.2007.00931.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The benefits derived from botulinum toxin (BTX) injections may be negated by unintentional weakness of adjacent uninjected muscles. Such weakness may be the result of inaccurate targeting, or diffusion of BTX to surrounding muscles. Several techniques, using electromyographic, endoscopic or imaging guidance are purported to increase the accuracy of targeting. Diffusion of BTX is thought to be influenced by factors such as dose, concentration, injectate volume, number of injections, site and rate of injection, needle gauge, muscle size, muscular fascia, distance of needle tip from the neuromuscular junction, and protein content of the BTX formulation. This article describes techniques that aim to increase the accuracy of BTX injections and examines the controversies surrounding diffusion of BTX following injection.
Collapse
Affiliation(s)
- E C-H Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, and National University Hospital, Singapore.
| | | |
Collapse
|
|
31
|
Abstract
Dystonia may be a sign or symptom, that is comprised of complex abnormal and dynamic movements of different etiologies. A specific cause is identified in approximately 28% of patients, which only occasionally results in specific treatment. In most cases, treatment is symptomatic and designed to relieve involuntary movements, improve posture and function and reduce associated pain. Therapeutic options are dictated by clinical assessment of the topography of dystonia, severity of abnormal movements, functional impairment and progression of disease and consists of pharmacological, surgical and supportive approaches. Several advances have been made in treatment with newer medications, availability of different forms of botulinum toxin and globus pallidus deep brain stimulation (DBS). For patients with childhood-onset dystonia, the majority of whom later develop generalized dystonia, oral medication is the mainstay of therapy. Recently, DBS has emerged as an effective alternative therapy. Botulinum toxin is usually the treatment of choice for those with adult-onset primary dystonia in which dystonia usually remains focal. In patients with secondary dystonia, treatment is challenging and efficacy is typically incomplete and partially limited by side effects. Despite these treatment options, many patients with dystonia experience only partial benefit and continue to suffer significant disability. Therefore, more research is needed to better understand the underlying cause and pathophysiology of dystonia and to explore newer medications and surgical techniques for its treatment.
Collapse
Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn University Hospital, Chulalongkorn Comprehensive Movement Disorders Center, Division of Neurology, 1873 Rama 4 Road Bangkok 10330, Thailand.
| | | |
Collapse
|
|
32
|
Abstract
Botulinum toxin (BoNT) treatment has been used extensively for the treatment of cervical dystonia. In most studies, there is significant improvement following treatment for head posture and pain. The common side effects following treatment include dysphagia, dry mouth, and neck weakness. There are five brands and two serotypes of BoNT available. The dosing of each serotype and brand differs. Perhaps more importantly, each brand and serotype may differ in immunogenic potential and occurrence of secondary unresponsiveness, an issue that is currently under active investigation. Although many aspects of the technique of injection have not been adequately studied, general guidelines are available.
Collapse
Affiliation(s)
- C L Comella
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA.
| | | |
Collapse
|
|
33
|
Zetterberg L, Halvorsen K, Färnstrand C, Lundström E, Lindmark B, Aquilonius SM. Objective assessment of cervical dystonia: a pilot study. Acta Neurol Scand 2005; 112:248-53. [PMID: 16146495 DOI: 10.1111/j.1600-0404.2005.00472.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aims were to characterize the movements in cervical dystonia (CD) by using an estimate of the mechanical power and work involved in the movements and to describe this through a movement energy index (MEI). MATERIALS AND METHODS The subjects (patients n = 6, controls n = 6) were seated in front of a screen with a laser pointer attached to a headband while they performed standardized movements. A three-dimensional motion capture system was used and a test-retest was performed. RESULTS The mean value of MEI was significantly higher for the patients than for the controls. There was no significant difference between MEI from test to retest for the patients but there was a significant difference between MEI from test to retest for the controls. CONCLUSION This study suggests that MEI could be a useful measure for the quantification of movement dysfunction in CD and thus an objective outcome measure in comparison of different therapies.
Collapse
Affiliation(s)
- L Zetterberg
- Department of Neuroscience, Section of Physiotherapy, University of Uppsala, Uppsala, Sweden.
| | | | | | | | | | | |
Collapse
|
|
34
|
Kukurin GW. Reduction of cervical dystonia after an extended course of chiropractic manipulation: a case report. J Manipulative Physiol Ther 2004; 27:421-6. [PMID: 15319766 DOI: 10.1016/j.jmpt.2004.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The diminution of the signs and symptoms of cervical dystonia following an extended course of specific chiropractic manipulation is described. CLINICAL FEATURES A 38-year-old man had gross anterior-lateral torticollis, focal dystonia of the head and neck, and radicularlike pains which failed to respond to physical therapy, medication, and injection. INTERVENTIONS AND OUTCOMES Two specific spinal manipulative technique systems unique to the chiropractic profession (Applied Biostructural Therapy [ABT] and Atlas Coccygeal Technique [ACT]) were applied to the patient. The patient's grading on a modified cervical dystonia scale dropped from a grade 16 to a grade 5 after an extended course of these specific chiropractic manipulative techniques. CONCLUSIONS The application of Advanced Biostructural Therapy and Atlas Coccygeal chiropractic techniques for management of cervical dystonia is presented. Substantial reduction in the cervical dystonia rating scale was observed with this approach, even after standard medical interventions had failed.
Collapse
|
|
35
|
Abstract
Cervical dystonia (CD) is the most common form of dystonia encountered in a movement disorders clinic. The treatment of this focal dystonia has improved markedly with the advent on botulinum toxin (BTX) injections, which has now become the treatment of choice. Initial studies, even double-blind controlled trials, failed to show robust effect, largely as a result of poor design, often using fixed dosage and site of administration. When the BTX treatment is customized to the needs of the individual patients and the most involved muscles are targeted, the effects can be quite dramatic and the improvement usually lasts 3 to 4 months. Experience and improved skills can largely prevent the adverse effects such as dysphagia and neck weakness. Although there is no evidence that BTX slows the progression of the disease, as a result of early intervention with BTX, many of the long-term complications of CD, such as contractures and radiculopathy, have been largely eliminated.
Collapse
Affiliation(s)
- Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas 77030, USA.
| |
Collapse
|
|
36
|
Abstract
Botulinum toxins are among the most potent neurotoxins known to humans. In the past 25 years, botulinum toxin has emerged as both a potential weapon of bioterrorism and as a powerful therapeutic agent, with growing applications in neurological and non-neurological disease. Botulinum toxin is unique in its ability to target peripheral cholinergic neurons, preventing the release of acetylcholine through the enzymatic cleavage of proteins involved in membrane fusion, without prominent central nervous system effects. There are seven serotypes of the toxin, each with a specific activity at the molecular level. Currently, serotypes A (in two preparations) and B are available for clinical use, and have been shown to be safe and effective for the treatment of dystonia, spasticity, and other disorders in which muscle overactivity gives rise to symptoms. This review focuses on the pharmacology, electrophysiology, immunology, and application of botulinum toxin in selected neurological disorders.
Collapse
Affiliation(s)
- Cynthia L Comella
- Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison, Chicago, Illinois 60612, USA.
| | | |
Collapse
|
|
37
|
Kramer M, Schmid I, Sander S, Högel J, Eisele R, Kinzl L, Hartwig E. Guidelines for the intramuscular positioning of EMG electrodes in the semispinalis capitis and cervicis muscles. J Electromyogr Kinesiol 2003; 13:289-95. [PMID: 12706608 DOI: 10.1016/s1050-6411(03)00021-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The objective of the study was to establish guidelines for the application of fine-wire or needle electrodes in the semispinalis cervicis and semispinalis capitis muscles. First of all, measured data for the puncture angle and puncture depth of each muscle were determined in CT scans. Using a regression approach, a model relation of these data with the neck circumference was established. This made it possible to accurately determine the puncture angle and puncture depth on the basis of the known neck circumference. In a further step, the neck muscles of seven human cadavers were punctured with wires in order to check the workability of these guidelines. At the same time, the wires' positions in relation to important structures (nerves, vessels) were studied. Both muscles can be punctured with a high degree of reliability. However, when puncturing the semispinalis cervicis muscle, one has to pass through a layer that contains vessels, nevertheless the risk of injury is regarded as very small. The technique enables intramuscular EMG measurements of the two muscles in manifold clinical problems.
Collapse
Affiliation(s)
- M Kramer
- Department of Traumasurgery, Hand and Reconstructive Surgery, University of Ulm, Steinhövelstrasse 9, 89075 Ulm, Germany.
| | | | | | | | | | | | | |
Collapse
|
|
38
|
Abstract
Cervical dystonia (CD) manifests clinically through involuntary spasms of neck muscles, producing abnormal head and neck movements and postures, which is often associated with pain. CD is the most common form of focal dystonia presenting to movement disorders clinics. Chemodenervation with botulinum toxin (BTX) has become the first-line treatment for CD, producing satisfactory relief of symptoms in > 80% of cases. Unresolved issues that may impact on the overall results include the method of selection for injection sites (clinical vs. electromyography), dosing, dilution and the role and relative efficacy of the different BTX serotypes. A guiding therapeutic principle of BTX injections is to achieve optimal results with the lowest possible dosage and frequency of administration. This strategy is critical in order to keep the risk of immunoresistance at a minimum. Development of antibodies that block the effects of BTX, usually associated with frequent injections of high doses, is the main reason for secondary unresponsiveness to this treatment. Although the mechanism of denervation at the neuromuscular junction by BTX is relatively well understood, the role of changes in muscle spindles and myopathic pain mechanisms, as well as secondary changes at the level of the basal ganglia, thalamus and cortex and their role in response to BTX, all need further exploration.
Collapse
Affiliation(s)
- R Tintner
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas 77030, USA.
| | | |
Collapse
|