Ultrasound guidance for botulinum neurotoxin therapy: cervical dystonia

2014 ◽  
pp. 46-59 ◽  
Author(s):  
Katharine E. Alter
Keyword(s):  
Cervical Dystonia ◽  
Botulinum Neurotoxin ◽  
Ultrasound Guidance

scholarly journals Management of cervical dystonia with botulinum neurotoxins and EMG/ultrasound guidance

2018 ◽  
Vol 9 (1) ◽  
pp. 64-73 ◽  
Author(s):  
Anna Castagna ◽  
Alberto Albanese
Keyword(s):  
Adverse Events ◽  
Muscle Activity ◽  
Cervical Dystonia ◽  
Botulinum Neurotoxin ◽  
Current Practice ◽  
Ultrasound Guidance ◽  
Clinical Approach ◽  
Botulinum Neurotoxins ◽  
Neck Anatomy ◽  
Us Findings

Purpose of reviewWe provide a practical guide on the use of electromyography (EMG) and ultrasound (US) to assist botulinum neurotoxin (BoNT) treatment in patients with cervical dystonia (CD).Recent findingsUS and EMG guidance improve BoNT treatment in CD. Their use is particularly valuable for targeting deep neck muscles and managing complex cases. There is also evidence that adverse events are reduced when superficial or intermediate layer muscles are injected with assisted guidance.SummaryA structured clinical approach, based on functional neck anatomy, guides CD assessment and BoNT treatment. Muscles are selected according to clinical, EMG and US findings. US provides anatomical visualization, while EMG complements by detecting muscle activity. We review here the current practice for assisted treatment of CD through BoNT cycles. We also describe how to recognize and manage the main adverse events.

scholarly journals Botulinum toxin injection changes resting state cerebellar connectivity in cervical dystonia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pavel Hok ◽  
Lenka Hvizdošová ◽  
Pavel Otruba ◽  
Michaela Kaiserová ◽  
Markéta Trnečková ◽  
...  
Keyword(s):  
Functional Mri ◽  
Resting State ◽  
Cervical Dystonia ◽  
Botulinum Neurotoxin ◽  
Botulinum Toxin Injection ◽  
Clinical Severity ◽  
Before And After ◽  
Positive Correlations ◽  
Using Data ◽  
The Right

AbstractIn cervical dystonia, functional MRI (fMRI) evidence indicates changes in several resting state networks, which revert in part following the botulinum neurotoxin A (BoNT) therapy. Recently, the involvement of the cerebellum in dystonia has gained attention. The aim of our study was to compare connectivity between cerebellar subdivisions and the rest of the brain before and after BoNT treatment. Seventeen patients with cervical dystonia indicated for treatment with BoNT were enrolled (14 female, aged 50.2 ± 8.5 years, range 38–63 years). Clinical and fMRI examinations were carried out before and 4 weeks after BoNT injection. Clinical severity was evaluated using TWSTRS. Functional MRI data were acquired on a 1.5 T scanner during 8 min rest. Seed-based functional connectivity analysis was performed using data extracted from atlas-defined cerebellar areas in both datasets. Clinical scores demonstrated satisfactory BoNT effect. After treatment, connectivity decreased between the vermis lobule VIIIa and the left dorsal mesial frontal cortex. Positive correlations between the connectivity differences and the clinical improvement were detected for the right lobule VI, right crus II, vermis VIIIb and the right lobule IX. Our data provide evidence for modulation of cerebello-cortical connectivity resulting from successful treatment by botulinum neurotoxin.

scholarly journals Patient perspectives on the therapeutic profile of botulinum neurotoxin type A in cervical dystonia

2020 ◽  
Author(s):  
Cynthia Comella ◽  
Joaquim J. Ferreira ◽  
Emilie Pain ◽  
Marion Azoulai ◽  
Savary Om
Keyword(s):  
Quality Of Life ◽  
Cervical Dystonia ◽  
Botulinum Neurotoxin ◽  
Type A ◽  
Peak Effect ◽  
Botulinum Neurotoxin Type A ◽  
The Mean ◽  
The Impact ◽  
Therapeutic Profile

Abstract Background Botulinum neurotoxin type A (BoNT-A) is an effective pharmacological treatment for the management of cervical dystonia (CD) that requires repeated administration at variable intervals. We explored patient perceptions of the impact of CD and the waning of BoNT-A therapeutic effects. Methods An internet-based survey was conducted through Carenity, a global online patient community, from May to September 2019. Eligible respondents were adults with CD who had ≥ 2 previous BoNT-A injections. Results 209 respondents (81% females; mean age of 49.7 years) met the screening criteria. The mean BoNT-A injection frequency was 3.9 injections/year. The mean reported onset of BoNT-A therapeutic effect was 11.7 days and the time to peak effect was 4.5 weeks. Symptom re-emergence between injections was common (88%); the time from injection to symptom re-emergence was 73.6 days (~ 10.5 weeks). Treatment was not reported to completely abolish symptoms, even at peak effect. However, symptom severity was rated (0 = no symptoms; 10 = very strong symptoms) as lowest at the peak of treatment effects (mean scores ~ 3/10), increasing as the effects of treatment start waning (~ 5.5/10) and was strongest one day before the next session (~ 7–8/10). The impact of CD on quality of life followed the same ‘rollercoaster’ pattern. Conclusions This survey highlights the burden of CD symptoms, even in patients undergoing regular treatment. Symptom re-emergence is common and has significant impact on daily activities and quality of life. Greater awareness of the therapeutic profile of BoNT-A treatment should lead to better informed therapeutic discussions and planning.

Sign in / Sign up

Export Citation Format

Share Document