A methodological approach for botulinum neurotoxin injections to the longus colli muscle in dystonic anterocollis: A case series of 4 patients and a literature review

Abstract

We review the current approaches and their feasibility to treat dystonic anterocollis by injecting longus colli muscle (LCo) with botulinum neurotoxin (BoNT) as well as present our personal experiences in this field compared with the findings from previously published studies. First, we searched the PubMed database for the publications reporting patients who received LCo injections for anterocollis; we also thoroughly examined the references included in each of the found publications. Second, we present and analyze our own experiences in injecting LCo under EMG guidance in patients with dystonic anterocollis due to heredodegenerative disorders. We found 11 publications describing administration of LCo injections for the treatment of dystonic anterocollis in a total of 28 patients with primary dystonia aged between 21 and 80 years. The mean age of our patients was 44.8 years with the mean anterocollis duration being 15 months. OnabotulinumtoxinA in a dose of up to 35 U per LCo muscle was not associated with the development of transient dysphagia. The mean percentage of patient satisfaction was 36.3%, and the mean duration of the beneficial effect was 2.5 months. All patients agreed to receive a repeat injection. We provide a set of empirically based suggestions on the current use of BoNT injections to LCo for managing anterocollis in outpatient clinics, including pretreatment work-up, injection technique, and dose range.

Treatment of axial postural abnormalities in parkinsonism disorders: A systematic review of pharmacological, rehabilitative and surgical interventions

“… n.r. Poor − 4 Seliverstov et al 2020 [51] Case series 2 (1 M,1F) Cognitive status n.r. Patient 1: 11 Patient 2: 8 -n.r.…”

“…BoNT serotypes A injection, including Abobotulinumtoxin [48] , [49] and Onabotulinumtoxin [50] , [51] was studied in patients with PD with AC. The injection dose of BoNT is variable among studies and based on the type of BoNT and site of injection.…”

“…The injection dose of BoNT is variable among studies and based on the type of BoNT and site of injection. Three studies used EMG-guided BoNT injection [48] , [50] , [51] , while one did not report the method of injection [49] . The muscles injected were unilateral/bilateral Levator scapulae (n = 4) [48] , [49] , [50] , [51] , Sternocleidomastoid muscle (n = 2) [48] , [50] , splenius capitis (n = 1) [48] , Longus collis (n = 1) [51] , Anterior/Medial Scalene (n = 2) [49] , [51] .…”

“…Three studies used EMG-guided BoNT injection [48] , [50] , [51] , while one did not report the method of injection [49] . The muscles injected were unilateral/bilateral Levator scapulae (n = 4) [48] , [49] , [50] , [51] , Sternocleidomastoid muscle (n = 2) [48] , [50] , splenius capitis (n = 1) [48] , Longus collis (n = 1) [51] , Anterior/Medial Scalene (n = 2) [49] , [51] . Several outcome measurements, including objective and subjective outcome measurements, were used to evaluate the efficacy of BoNT injection.…”

The Downside of Botulinum Injections for Anterocollis: A Case Series and a Review of the Literature

“…Targeting longus colli can be considered, if injections of the superficial neck muscles failed. However, the longus colli muscles run the length of the anterior cervical vertebral column and behind major blood vessels, therefore, only a few clinics have the expertise to administer this safely 11,19 . In addition, because of its long shape, injections targeting the entire longus colli are not very realistic and a single injection of such a long muscle likely would have a limited effect.…”