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

Abstract

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.

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

“…of participants (no. of females) Cognitive status PD duration (years) -H&Y stage if reported Total Toxin Dose per Injection Cycle, Method, and Muscle injected Type of PA – PA Duration (y)-Diagnostic Criteria Study outcomes measures Main Results Follow-up QA-LE Yahalom et al 2023 [49] Case series 1 (M) Cognitive status n.r. Nr- nr Abobotulinumtoxin (Dysport) Bilateral Medial Scalene (50 U).Bilateral Levator Scapulae (25 U).Method: 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.…”

Botulinum Toxin for Axial Postural Abnormalities in Parkinson’s Disease: A Systematic Review

“…In terms of quality, most studies were assessed as being of poor quality (n = 6) [35,[82][83][84][85][86]. However, two studies were rated as good quality [87,88] and five as fair [89][90][91][92][93].…”