Cervical Dystonia

Cervical dystonia, which is the most common form of focal dystonia, presents with sustained neck spasms, abnormal head posture, head tremor, and pain. One of the interesting and unique features of cervical dystonia is the geste antagoniste. There is not a well-described pathophysiology for cervical dystonia, but several hypotheses report involvement at the central and peripheral level. Treatment options include: oral medical therapy, botulinum toxin injection, and surgery. Oral medical therapy has limited efficacy in control of the symptoms of cervical dystonia. Two types of botulinum toxin, types A and B, are being used for treatment of cervical dystonia, with equivalent benefit. Surgery is an option when other treatments fail or become ineffective. The surgical procedures are brain lesioning, brain stimulation, and peripheral surgical intervention. Several trials are currently ongoing in the United States and Europe to evaluate the efficacy of deep brain surgery in cervical dystonia.

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Treatment of Focal Hyperhidrosis

Journal of Cutaneous Medicine and Surgery ◽

10.2310/7750.2007.00012 ◽

2007 ◽

Vol 11 (2) ◽

pp. 67-77 ◽

Cited By ~ 17

Author(s):

Christian A. Murray ◽

Joel L. Cohen ◽

Nowell Solish

Keyword(s):

Botulinum Toxin ◽

Botulinum Toxin A ◽

Botulinum Toxin Injection ◽

Treatment Options ◽

The United States ◽

Mild Disease ◽

The United Kingdom ◽

Surgical Options ◽

Focal Hyperhidrosis

Background: Focal hyperhidrosis is not rare, affecting over 2.5% of the population. This condition is often socially and professionally debilitating, leading to significant quality of life impairment. It most commonly involves the axillae, palms, soles, and face. Objective: To review hyperhidrosis and discuss and compare the treatment options currently available. Conclusions: Topical or systemic therapies may be helpful for patients with mild disease. Invasive surgical options, although often effective, are limited by complications. More recently, botulinum toxin injection has proven to be a safe and successful treatment for hyperhidrosis and results in high patient satisfaction. Botulinum toxin A (Botox, Allergan Inc., Irvine, CA) is currently approved in the United States, Canada, the United Kingdom, and many other countries for the treatment of axillary hyperhidrosis and is routinely used off-label for other anatomic sites.

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A Systematic Review of the Omohyoid Muscle Syndrome (OMS): Clinical Presentation, Diagnosis, and Treatment Options

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489421995037 ◽

2021 ◽

pp. 000348942199503

Author(s):

Jerome Zhiyi Ong ◽

Alex Chengyao Tham ◽

Jian Li Tan

Keyword(s):

Systematic Review ◽

Botulinum Toxin ◽

Traumatic Event ◽

Botulinum Toxin Injection ◽

Treatment Options ◽

Neck Mass ◽

Good Prognosis ◽

Common Symptom ◽

Management Options ◽

Omohyoid Muscle

Objective: Omohyoid muscle syndrome (OMS) is a condition that causes a X-shaped lateral neck lump on swallowing, caused by the failure of the central tendon of the omohyoid muscle to restrict movement of the muscle during swallowing. We aim to review the etiology, pathophysiology, diagnostic tests, and management options for this condition. Data Sources: Pubmed, MEDLINE, EMBASE, and Cochrane databases were searched for all articles and abstracts related to OMS up to 29th July 2020. Review Methods: A systematic review was performed, data extracted from relevant full text articles. Both quantitative data and qualitative data were analyzed. Results: Twenty cases of OMS were reported. Patients presented at a mean age of 36.0. All cases were Asian. There is a 7:3 ratio of males to females. The most common symptom was a transient neck mass. Most cases were managed conservatively with good prognosis. Open or endoscopic transection of the muscle and ultrasound-guided botulinum toxin injection were 3 treatment options, with no recurrence at 4 years, 6 months, and 6 months respectively. Conclusion: OMS could be genetic as all cases were Asian in ethnicity. The deep cervical fascia which usually envelopes the omohyoid muscle may be weakened by stress as 20% of cases had a preceding traumatic event. Real-time ultrasonography establishes the diagnosis, demonstrating the anterolateral displacement of the sternocleidomastoid muscle by a thickened omohyoid muscle during swallowing. Surgical transection can achieve cure, but due to limited studies available, they should be reserved for patients who are extremely bothered. Intramuscular injection of botulinum toxin is an effective alternative, but recurrence is expected.

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Effective botulinum toxin injection guide for treatment of cervical dystonia

Clinical Anatomy ◽

10.1002/ca.23430 ◽

2019 ◽

Vol 33 (2) ◽

pp. 192-198 ◽

Cited By ~ 4

Author(s):

Kyu‐Ho Yi ◽

You‐Jin Choi ◽

Liyao Cong ◽

Kyu‐Lim Lee ◽

Kyung‐Seok Hu ◽

...

Keyword(s):

Botulinum Toxin ◽

Cervical Dystonia ◽

Botulinum Toxin Injection

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Severe dysphagia after botulinum toxin injection for cervical dystonia in multiple system atrophy

Movement Disorders ◽

10.1002/mds.1101 ◽

2001 ◽

Vol 16 (4) ◽

pp. 764-765 ◽

Cited By ~ 20

Author(s):

S. Thobois ◽

E. Broussolle ◽

L. Toureille ◽

C. Vial

Keyword(s):

Botulinum Toxin ◽

Multiple System Atrophy ◽

Cervical Dystonia ◽

Botulinum Toxin Injection ◽

Severe Dysphagia

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Long-Term Successful Outcome of Dystonic Head Tremor after Bilateral Deep Brain Stimulation of the Ventral Intermediate and Ventro-Oral Internus Nuclei: A Case Report and Literature Review of Dystonic Head Tremor

Stereotactic and Functional Neurosurgery ◽

10.1159/000510593 ◽

2021 ◽

pp. 1-6

Author(s):

Hayato Yamahata ◽

Shiro Horisawa ◽

Kenichi Hodotsuka ◽

Takakazu Kawamata ◽

Takaomi Taira

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Cervical Dystonia ◽

Successful Outcome ◽

Treatment Target ◽

Dystonic Tremor ◽

Head Tremor ◽

Deep Brain ◽

Stimulation Of

Head tremor in patients with dystonia is referred to as dystonic tremor. During surgical treatment, numerous targets may be selected, including the internal segment of the globus pallidus and the ventral intermediate (Vim) nucleus; however, there is no consensus concerning the most effective treatment target. We report herein a case of dystonic head tremor in which improvement persisted for 5 years after deep brain stimulation (DBS) of the bilateral thalamic Vim and ventro-oral internus (Voi) nuclei. The patient, a 67-year-old woman, has a horizontal head tremor associated with cervical dystonia that had been resistant to drug treatment over 3 years. Immediately following surgery, dystonia and tremor symptoms had completely improved. Voice volume declined and dysarthria occurred but improved upon adjusting the stimulation conditions. Over 5 years, both head tremor and cervical dystonia have been completely controlled, and no other obvious complications have been observed. As the Voi nucleus receives pallidothalamic projections involved in dystonia and the Vim nucleus receives cerebellothalamic projections involved in tremors, stimulating these 2 nuclei with the same electrode appears reasonable in the treatment of dystonic tremor. This case suggests that Vim-Voi DBS may be effective for treating dystonic head tremor.

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Medications and Botulinum Toxin for Overactive Bladder

10.2310/tywc.11064 ◽

2020 ◽

Author(s):

Kirin K Syed ◽

Angelo E Gousse

Keyword(s):

Botulinum Toxin ◽

Overactive Bladder ◽

Treatment Options ◽

Symptom Control ◽

The United States ◽

Office Visits ◽

Phosphodiesterase Type 5 Inhibitors ◽

Symptom Complex ◽

Phosphodiesterase Type ◽

Nonneurogenic Overactive Bladder

Previously published literature has estimated that approximately 16.5% of American adults have OAB, and up to 37% of OAB patients have concomitant urinary incontinence (OAB-wet). In fact, OAB is one the most common urologic disorders, accounting for more than 2 million physician office visits in the United States (2007). Nonneurogenic OAB is a symptom complex, which is defined by the International Continence Society standardization committee as urgency, with or without urgency incontinence, usually with frequency and nocturia, in the absence of proven infection or other obvious pathology. Urgency with at least one other symptom is essential to diagnose OAB and is the cornerstone component of OAB. To date, there is a paucity of validated instruments to define urinary urgency, and therefore, the diagnosis of OAB is based on patient symptomatology. Diagnosis does not rely on urodynamic findings or characteristics and therefore a thorough history and physical examination are essential. Treatment for this nonsurgical condition is therefore aimed toward symptom control. This review provides the reader with a better understanding of the voiding cycle and available medical treatment options for nonneurogenic overactive bladder (OAB). This review contains 11 figures, 7 tables, and 90 references. Key Words: anticholinergic, β3 agonist, botulinum toxin, chemodenervation, cialis, intradetrusor onabotulinumtoxinA, micturation cycle, mirabegron, overactive bladder, phosphodiesterase type 5 inhibitors, urinary retention

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P66 Should we be screening for depression and quality of life in all patients attending botulinum toxin injection clinics or just those with cervical dystonia?

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.128 ◽

2019 ◽

Vol 90 (3) ◽

pp. e40.1-e40

Author(s):

R Mozdiak ◽

R Lally ◽

F Osei-Poku ◽

J Alty

Keyword(s):

Quality Of Life ◽

Botulinum Toxin ◽

Pilot Study ◽

Cervical Dystonia ◽

Botulinum Toxin Injection ◽

Cross Sectional ◽

Female Age ◽

Meige Syndrome ◽

Prevalence Of Depression

ObjectivesCervical dystonia (CD) is known to be associated with depression and low quality of life (QoL) but we know little about these measures in non-CD patients attending botulinum toxin clinics. The objective was to evaluate the prevalence of depression and low QoL in both CD and nonCD patients.DesignCross-sectional pilot study.SubjectsConsecutive patients attending teaching hospital botulinum toxin clinic.MethodsPatients completed the Beck’s Depression Inventory (BDI) questionnaire and a Recovering Quality of Life (ReQoL) scale. BDI and ReQoL scores of ≥17 and≤24 indicated depression and impaired QoL respectively.Results48 patients (30 female; age 45–75 years) were evaluated; 33:15 CD:non-CD. The non-CD group comprised hemifacial spasm, upper limb dystonia/tremor, blepharospasm and Meige syndrome. 23% (11/48) of all patients had depression: 27% (9/33) of CD and 13% (2/15) of non-CD. Depression rates were more frequent amongst females and males (27%; 17%) (p=0.43). 34% of all patients had low QoL – 36% (12/33) and 27% (4/15) in the CD and non-CD groups respectively (p=0.51). Low QoL scores were more frequent in females (40%) than males (22%) but this difference was not significant (p=0.21).ConclusionsDepression and low quality of life were common in all patients in this pilot study. This suggests that screening of all patients attending botulinum toxin clinics, regardless of their diagnosis, may be clinically important. A larger study is required to validate these findings.

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Cervical Dystonia and Executive Function: A Pilot Magnetoencephalography Study

Brain Sciences ◽

10.3390/brainsci8090159 ◽

2018 ◽

Vol 8 (9) ◽

pp. 159 ◽

Cited By ~ 2

Author(s):

Abhimanyu Mahajan ◽

Andrew Zillgitt ◽

Abdullah Alshammaa ◽

Neepa Patel ◽

Christos Sidiropoulos ◽

...

Keyword(s):

Executive Function ◽

Botulinum Toxin ◽

Cervical Dystonia ◽

Botulinum Toxin Injection ◽

Neuropsychological Testing ◽

Network Connectivity ◽

Brain Regions ◽

Continuous Performance Task ◽

Source Imaging ◽

Before And After

Background: Cervical dystonia (CD) patients have impaired working memory, processing speed and visual-motor integration ability. We used magnetoencephalography (MEG) to investigate changes in cerebral oscillations in CD patients during an executive function test, before and after administration of botulinum toxin. Methods: MEG data were collected from five CD patients while they performed a visual continuous performance task (CPT), before and after they received a botulinum toxin injection. MEG data was also collected on five controls matched for age and gender. Coherence source imaging was performed to quantify network connectivity of subjects. Results: Controls demonstrated two errors with visual CPT; CD patients demonstrated six and three errors pre- and post-botulinum toxin respectively. After botulinum toxin, mean time from cue to correct response was 0.337 s in controls, 0.390 s in patients before botulinum toxin injection, and 0.366 s after the injection. Differences in coherence between controls and patients were found in the following brain regions: Fronto-frontal, fronto-parietal, fronto-striatal, fronto-occipital, parieto-parietal and temporo-parietal. Intrahemispheric and interhemispheric networks were affected. Post injection, there was minimal change in coherence in the above-mentioned networks. Discussion: Neuropsychological testing suggests difference in coherence in frontal circuits between CD cases and controls during the visual CPT, which may reflect subjects’ increased difficulty with the task. Botulinum toxin is associated with minimal improvement with executive function in CD.

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