Book contents
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Chapter 1 The pretherapeutic history of botulinum neurotoxin
- Chapter 2 Botulinum neurotoxin: history of clinical development
- Chapter 3 Pharmacology of botulinum neurotoxins
- Chapter 4 Immunological properties of botulinum neurotoxins
- Chapter 5 Treatment of cervical dystonia
- Chapter 6 Examination and treatment of complex cervical dystonia
- Chapter 7 Ultrasound guidance for botulinum neurotoxin therapy: cervical dystonia
- Chapter 8 Treatment of blepharospasm
- Chapter 9 Botulinum neurotoxin in oromandibular dystonia
- Chapter 10 Treatment of focal hand dystonia
- Chapter 11 Botulinum neurotoxin therapy of laryngeal muscle hyperactivity syndromes
- Chapter 12 The use of botulinum neurotoxin in otorhinolaryngology
- Chapter 13 Treatment of hemifacial spasm
- Chapter 14 Spasticity
- Chapter 15 The use of botulinum neurotoxin in spastic infantile cerebral palsy
- Chapter 16 The role of ultrasound for botulinum neurotoxin injection in childhood spasticity
- Chapter 17 The use of botulinum neurotoxin in spasticity using ultrasound guidance
- Chapter 18 The use of botulinum neurotoxin in tic disorders and essential hand and head tremor
- Chapter 19 Treatment of stiff-person syndrome with botulinum neurotoxin
- Chapter 20 Botulinum neurotoxin applications in ophthalmology
- Chapter 21 Cosmetic uses of botulinum neurotoxins
- Chapter 22 Hyperhidrosis
- Chapter 23 Botulinum neurotoxin A treatment for ischemic digits
- Chapter 24 Botulinum neurotoxin in wound healing
- Chapter 25 Use of botulinum neurotoxin in neuropathic pain
- Chapter 26 The use of botulinum neurotoxin in the management of headache disorders
- Chapter 27 The use of botulinum neurotoxin in musculoskeletal pain and arthritis
- Chapter 28 Treatment of plantar fasciitis with botulinum neurotoxins
- Chapter 29 Use of botulinum neurotoxin in the treatment of low-back pain
- Chapter 30 Use of botulinum neurotoxin in the treatment of piriformis syndrome
- Chapter 31 Ultrasound-guided botulinum neurotoxin injections for thoracic outlet syndrome
- Chapter 32 Botulinum neurotoxin in the gastrointestinal tract
- Chapter 33 Botulinum neurotoxin applications in urological disorders
- Index
- References
Chapter 6 - Examination and treatment of complex cervical dystonia
Published online by Cambridge University Press: 05 February 2014
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Chapter 1 The pretherapeutic history of botulinum neurotoxin
- Chapter 2 Botulinum neurotoxin: history of clinical development
- Chapter 3 Pharmacology of botulinum neurotoxins
- Chapter 4 Immunological properties of botulinum neurotoxins
- Chapter 5 Treatment of cervical dystonia
- Chapter 6 Examination and treatment of complex cervical dystonia
- Chapter 7 Ultrasound guidance for botulinum neurotoxin therapy: cervical dystonia
- Chapter 8 Treatment of blepharospasm
- Chapter 9 Botulinum neurotoxin in oromandibular dystonia
- Chapter 10 Treatment of focal hand dystonia
- Chapter 11 Botulinum neurotoxin therapy of laryngeal muscle hyperactivity syndromes
- Chapter 12 The use of botulinum neurotoxin in otorhinolaryngology
- Chapter 13 Treatment of hemifacial spasm
- Chapter 14 Spasticity
- Chapter 15 The use of botulinum neurotoxin in spastic infantile cerebral palsy
- Chapter 16 The role of ultrasound for botulinum neurotoxin injection in childhood spasticity
- Chapter 17 The use of botulinum neurotoxin in spasticity using ultrasound guidance
- Chapter 18 The use of botulinum neurotoxin in tic disorders and essential hand and head tremor
- Chapter 19 Treatment of stiff-person syndrome with botulinum neurotoxin
- Chapter 20 Botulinum neurotoxin applications in ophthalmology
- Chapter 21 Cosmetic uses of botulinum neurotoxins
- Chapter 22 Hyperhidrosis
- Chapter 23 Botulinum neurotoxin A treatment for ischemic digits
- Chapter 24 Botulinum neurotoxin in wound healing
- Chapter 25 Use of botulinum neurotoxin in neuropathic pain
- Chapter 26 The use of botulinum neurotoxin in the management of headache disorders
- Chapter 27 The use of botulinum neurotoxin in musculoskeletal pain and arthritis
- Chapter 28 Treatment of plantar fasciitis with botulinum neurotoxins
- Chapter 29 Use of botulinum neurotoxin in the treatment of low-back pain
- Chapter 30 Use of botulinum neurotoxin in the treatment of piriformis syndrome
- Chapter 31 Ultrasound-guided botulinum neurotoxin injections for thoracic outlet syndrome
- Chapter 32 Botulinum neurotoxin in the gastrointestinal tract
- Chapter 33 Botulinum neurotoxin applications in urological disorders
- Index
- References
Summary
Introduction
Botulinum neurotoxin (BoNT) serotype A (BoNT-A) is the treatment of choice for cervical dystonia (CD). Treatment outcome can vary with the presentation of CD and is significantly dependent on the correct assessment of the muscle involved.
There are “simple” (movement disorders in one plane) and “complex” (movement disorder in two or more levels) forms of CD. The most common presentation is the rotation and tilting of the head. The difficulty lies in the treatment of complex CD. In large studies, rates of patient satisfaction with the BoNT therapy range from 50 to 60% (Comella et al., 2000; Haussermann et al., 2004; Truong et al., 2010). The most common cause of unsatisfactory treatment is the selection of the wrong muscle. The selection of the treated muscles is most effective if the actual clinical picture of complex CD in a patient is considered as an individual situation.
In a large study with imaging (MRI, CT) in patients with CD, it was noted that the previous phenomenological classification of CD in four groups (torticollis, laterocollis, antecollis and retrocollis) is inadequate. There are clinical cases of CD in which only muscles that act on the head are involved, and others involving only muscles that act on the cervical spine (Reichel, 2009, 2012). Therefore, a more extensive complex cervical movement disorder clinical analysis beyond the four traditional groups is required. The objective is a precise delineation of an optimal individualized treatment strategy in the selection of muscle involved. As the selection of the treated muscles and finding the individual BoNT dose can be difficult, different diagnostic methods are used. They include ultrasound, CT neck soft tissue imaging (particularly the deep muscles of the neck), electromyography (EMG) of neck muscles and standardized photographs of patients with measurements of angles (head, neck, thorax). The presence of a lateral shift or forward sagittal shift (very rarely backward) suggests a combination of two clinical pictures: lateral shift occurs when a laterocollis is combined with a laterocaput to the opposite side (Fig. 6.1a). A sagittal shift forward occurs when an antecollis is combined with a retrocaput. A sagittal shift to the rear is also possible (combination of retrocollis and antecaput) but occurs very rarely isolated, most likely with generalized dystonia.
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- Manual of Botulinum Toxin Therapy , pp. 35 - 45Publisher: Cambridge University PressPrint publication year: 2014