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

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.

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Ultrasound guidance for botulinum neurotoxin therapy: cervical dystonia

Manual of Botulinum Toxin Therapy ◽

10.1017/cbo9781139178068.008 ◽

2014 ◽

pp. 46-59 ◽

Cited By ~ 1

Author(s):

Katharine E. Alter

Keyword(s):

Cervical Dystonia ◽

Botulinum Neurotoxin ◽

Ultrasound Guidance

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Botulinum neurotoxins C, E and F bind gangliosides via a conserved binding site prior to stimulation-dependent uptake with botulinum neurotoxin F utilising the three isoforms of SV2 as second receptor

Journal of Neurochemistry ◽

10.1111/j.1471-4159.2009.06298.x ◽

2009 ◽

Vol 110 (6) ◽

pp. 1942-1954 ◽

Cited By ~ 121

Author(s):

Andreas Rummel ◽

Kirstin Häfner ◽

Stefan Mahrhold ◽

Natallia Darashchonak ◽

Matthew Holt ◽

...

Keyword(s):

Binding Site ◽

Botulinum Neurotoxin ◽

Botulinum Neurotoxins

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Botulinum toxin injection changes resting state cerebellar connectivity in cervical dystonia

Scientific Reports ◽

10.1038/s41598-021-87088-z ◽

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.

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EP.TU.571Is the pen mightier than the scalpel? Improving the quality and efficiency of Major Trauma ward rounds

British Journal of Surgery ◽

10.1093/bjs/znab311.077 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Ethlinn Patton ◽

Dapo Olaleye ◽

Stella Smith

Keyword(s):

Adverse Events ◽

Major Trauma ◽

Current Practice ◽

Oral Intake ◽

Cost Effective ◽

Poor Quality ◽

Ward Round ◽

Before And After ◽

Ward Rounds ◽

Gathering Data

Abstract Aims Methods Data was collected retrospectively between October to December 2020. Patient paper notes were reviewed on three dates before and after implementation of the ward round sticker, gathering data from 26 and 27 patients respectively. Data was collected across a series of weeks to ensure a variety of clinicians present on ward round, in order to accurately reflect current practice. Results An improvement in rate of documentation was seen in 10 out of 12 key clinical variables. Some of the largest increases were seen in consideration of VTE status; 96.3% (n = 26) from 7.69% (n = 2), and recording oral intake; 85.2% (n = 23) from 23.1% (n = 6.) Conclusions We know that poor quality documentation is associated with increased rates of adverse events for patients,[1] so it is imperative to address both what is being covered, and how it is being recorded. Staff reported that the use of ward round stickers improved legibility of documentation and made it easier to locate important information. This simple, cost effective intervention has improved the consistency of daily reviews, and streamlined communication within the multidisciplinary team.

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Decision letter for "Subjective versus objective symptom intensities ratings in cervical dystonia and hemifacial spasm across a botulinum neurotoxin cycle"

10.1002/brb3.2023/v1/decision1 ◽

2020 ◽

Keyword(s):

Hemifacial Spasm ◽

Cervical Dystonia ◽

Botulinum Neurotoxin

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Variations in the Botulinum Neurotoxin Binding Domain and the Potential for Novel Therapeutics

Toxins ◽

10.3390/toxins10100421 ◽

2018 ◽

Vol 10 (10) ◽

pp. 421 ◽

Cited By ~ 7

Author(s):

Jonathan Davies ◽

Sai Liu ◽

K. Acharya

Keyword(s):

Botulinum Neurotoxin ◽

Neuronal Cell ◽

Binding Domain ◽

Novel Therapeutics ◽

Specific Targeting ◽

Zinc Metalloprotease ◽

Botulinum Neurotoxins ◽

Translocation Domain ◽

Subtype Differences

Botulinum neurotoxins (BoNTs) are categorised into immunologically distinct serotypes BoNT/A to /G). Each serotype can also be further divided into subtypes based on differences in amino acid sequence. BoNTs are ~150 kDa proteins comprised of three major functional domains: an N-terminal zinc metalloprotease light chain (LC), a translocation domain (HN), and a binding domain (HC). The HC is responsible for targeting the BoNT to the neuronal cell membrane, and each serotype has evolved to bind via different mechanisms to different target receptors. Most structural characterisations to date have focussed on the first identified subtype within each serotype (e.g., BoNT/A1). Subtype differences within BoNT serotypes can affect intoxication, displaying different botulism symptoms in vivo, and less emphasis has been placed on investigating these variants. This review outlines the receptors for each BoNT serotype and describes the basis for the highly specific targeting of neuronal cell membranes. Understanding receptor binding is of vital importance, not only for the generation of novel therapeutics but also for understanding how best to protect from intoxication.

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Quantitative Electromyographic Analysis of Changes in Muscle Activity Following Botulinum Toxin Therapy for Cervical Dystonia

Clinical Neuropharmacology ◽

10.1097/00002826-199306000-00003 ◽

1993 ◽

Vol 16 (3) ◽

pp. 205-210 ◽

Cited By ~ 23

Author(s):

Aron S. Buchman ◽

Cynthia L. Cornelia ◽

Glenn T. Stebbins ◽

Caroline M. Tanner ◽

Christopher G. Goetz

Keyword(s):

Botulinum Toxin ◽

Muscle Activity ◽

Cervical Dystonia ◽

Botulinum Toxin Therapy ◽

Electromyographic Analysis

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Botulism (type A) in a horse - case report

Acta Veterinaria Brno ◽

10.2754/avb201685010071 ◽

2016 ◽

Vol 85 (1) ◽

pp. 71-76 ◽

Cited By ~ 1

Author(s):

Sevim Kasap ◽

Hasan Batmaz ◽

Meric Kocaturk ◽

Frank Gessler ◽

Serkan Catık ◽

...

Keyword(s):

Botulinum Neurotoxin ◽

Clinical Signs ◽

Type A ◽

Serum Samples ◽

Specific Antibodies ◽

Thoroughbred Horse ◽

Botulinum Neurotoxin Type A ◽

Botulinum Neurotoxins ◽

First Time ◽

Colonic Content

This paper presents the case of a six year-old, male, thoroughbred horse with clinical signs of inappetence, weakness, and incoordination when walking. Clinical examination showed that the horse staggered and leaned to the left side. Feedstuff was present inside and around its mouth. Salivation was increased and there was no reflex at the palpebrae and tongue. The horse had difficulty swallowing and the tone of its tail was reduced. Botulism was diagnosed based on the clinical signs. Antibiotic (ceftiofur) and fluid-electrolyte treatment was commenced. Next day, neostigmin was added to the horse’s treatment, and it became recumbent. The horse’s palpebral, tongue and tail reflexes returned partially after neostigmine methylsulphate treatment on the same day and it stood up on day four. However, it could not swallow anything during the whole week, so after getting permission from the owner, the horse was euthanized on day 10. Samples of the colonic content and blood serum were sent by courier to the laboratory for toxin neutralization, however, botulinum neurotoxins could not be detected. After that, serum samples from days 6 and 10 were sent to another laboratory for testing for botulinum neurotoxin antibodies by ELISA. Specific antibodies against botulinum neurotoxin type A were measured, indicating a previous, immuno-relevant contact with the toxin. This seroconversion for type A supports the clinical botulism diagnosis. Type A botulism is rarely seen in Europe and has been detected in a horse in Turkey for the first time.

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