Botulinum toxin treatment of dystonic anterocollis: What to inject

Marion, Marie-Hélène; Hicklin, Lucy A.

doi:10.1016/j.parkreldis.2021.05.024

Cited by 9 publications

(9 citation statements)

References 11 publications

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“…The hypothesis is that the levator scapulae become head and neck flexors in cervical dystonia 10,25 . It is assumed by Marion et al 11 that the prominent contraction of the levator scapulae muscles, which can be seen in these patients is compensatory, in an attempt to hold the head as upright and straight as possible on the cervical spine. Papapertropoulos et al 6 showed a favorable effect in 73.3% (13.3% with excellent response, 33.3% with good response and 26.7% with mild response), by injecting the SCM for anterocollis, without a discrimination according to the COL-CAP concept.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…Injections of the longus colli seem to be promising but from the anecdotal reports that were published, it seems that the therapeutic outcome is various, ranging from 20% to 30% improvement to a mean 78.6% satisfaction. 11,18 On a related note, the experience with injecting the SCM muscles has challenged the notion that these muscles are the major flexors of the neck. By default, the longus colli muscles seem to be more crucial to neck flexion.…”

Section: Discussionmentioning

confidence: 99%

“…The differentiation between anterocaput and anterocollis is described in details by Marion and Hicklin. 11 Anterocollis was prominent in the sitting and standing position but while expected to abate in the supine position, the latter was not performed.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2023

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Objectives: This is a case series and a review of the literature of therapeutic outcomes of botulinum toxin (BT) injections for anterocollis.Methods: Data collected included gender, age, age at onset, muscles targeted, and doses injected. Routine forms were filled out during each visit: Patient Global Impression of Change, Clinician Global Impression of Severity, Tsui scale. The effect duration and side effects (SEs) of the previous treatment were noted. Results:We described 4 patients (3 men, 13 visits) with anterocollis, as primary postural abnormality of the neck, emphasizing the therapeutic response to BT injection. Mean age at onset was 75.3 ± 7.0 years, age at first injection was 80.7 ± 3.5 years. The mean total dose per treatment was 290.0 ± 95.6 units. Patient Global Impression of Change with any grade of favorable effect was reported in 27.3% of the treatments. In objective assessment, Global Impression of Severity and Tsui scores did not show a consistent tendency of improvement. Neck weakness was prevalent in 18.2% of the visits of the anterocollis group while no other SEs were noted. We found 15 articles describing experience with BT for anterocollis in 67 patients (19 in deep and 48 in superficial neck muscles).Conclusions: This case series describes the poor outcome of BT treatment for anterocollis, with low efficacy and bothersome SE. Levator scapulae injection for anterocollis is not effective and is highly associated with head drop and should perhaps be abandoned. Injection to the longus colli might give some benefit in non-responders.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

et al. 2023

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“…Current investigations suggested an image-facilitated method, such as EMG, is more suitable for localizing the contracting muscles during injection. 19 This method is suitable for injecting muscles differing in size, and the deep-localized muscle requires a different approach compared to superficial ones. It can be noticed that the advantages and preferable treatment outcome of imageguided BoTX injection were reported, in most studies, were analyzed and interpreted utilizing a small sample size.…”

Section: Introductionmentioning

confidence: 99%

Proposed Potential Anatomical Landmarks for Percutaneous Botulinum Toxin Injection in Anterocollis-typed Cervical Dystonic Patient: A Pilot Study Utilizing Thiel-embalmed Human Cadavers

Cheewadhanaraks

Kumthornthip²,

Sangchay³

2022

Siriraj Med J

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Objective: Botulinum toxin (BoTX) injection to the longus colli (LCo) muscle has been demonstrated to have a role in treating cervical dystonic (CD) patients. It can, however, cause critical complications and awareness of such complications is required. Currently, there is no substantial information regarding this novel procedure. This study aims to define the potentially safe method of injection based on assessment of anatomical measurements.Materials and Methods: We examined distances between the puncture sites and adjacent structures in Thiel-embalmed human cadavers (n=20) to propose an alternative technique for BoTX injection. Parameters were examined for the medial and lateral approaches at the fifth and sixth cervical vertebral levels. We compared each variable between the two different vertebral levels and the two different approaches to evaluate statistical differences.Results: Comparing distances between the puncture sites and neck anatomical structures in each of the two approaches, results were statistically significant. Similarly, we found using the medial approach statistical significance when comparing the measurements at the fifth with the sixth cervical vertebral level of the distances between the puncture sites and the thyroidal arteries and recurrent laryngeal nerve (p < 0.05).Conclusion: The present study results provide initial guidelines for the safe technique for BoTX injection into LCo. Our findings suggest that the medial approach at the C6 vertebral level is preferable with minimal injury to vital structures. Thus, it may provide an optional method and can be used as guidance to improve surgical practice. Ethical approval was not required for this study.

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Parkinson’s Disease

Frucht,

Termsarasab

2024

Movement Disorders Phenomenology

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Botulinum toxin treatment of dystonic anterocollis: What to inject

Cited by 9 publications

References 11 publications

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

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

Proposed Potential Anatomical Landmarks for Percutaneous Botulinum Toxin Injection in Anterocollis-typed Cervical Dystonic Patient: A Pilot Study Utilizing Thiel-embalmed Human Cadavers

Parkinson’s Disease

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