scholarly journals Management of Anterocapitis and Anterocollis: A Novel Ultrasound Guided Approach Combined with Electromyography for Botulinum Toxin Injection of Longus Colli and Longus Capitis

Toxins ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 626
Author(s):  
Michael Farrell ◽  
Barbara I. Karp ◽  
Panagiotis Kassavetis ◽  
William Berrigan ◽  
Simge Yonter ◽  
...  
Keyword(s):  
Side Effects ◽  
Botulinum Neurotoxin ◽  
Botulinum Toxin Injection ◽  
Ultrasound Guided ◽  
Forward Flexion ◽  
Adjacent Structures ◽  
Longus Colli ◽  
Flexor Muscles ◽  
Cervical Musculature ◽  
Deep Location

Chemodenervation of cervical musculature using botulinum neurotoxin (BoNT) is established as the gold standard or treatment of choice for management of Cervical Dystonia (CD). The success of BoNT procedures is measured by improved symptomology while minimizing side effects and is dependent upon many factors including: clinical pattern recognition, identifying contributory muscles, BoNT dosage, and locating and safely injecting target muscles. In patients with CD, treatment of anterocollis (forward flexion of the neck) and anterocaput (anterocapitis) (forward flexion of the head) are inarguably challenging. The longus Colli (LoCol) and longus capitis (LoCap) muscles, two deep cervical spine and head flexor muscles, frequently contribute to these patterns. Localizing and safely injecting these muscles is particularly challenging owing to their deep location and the complex regional anatomy which includes critical neurovascular and other structures. Ultrasound (US) guidance provides direct visualization of the LoCol, LoCap, other cervical muscles and adjacent structures reducing the risks and side effects while improving the clinical outcome of BoNT for these conditions. The addition of electromyography (EMG) provides confirmation of muscle activity within the target muscle. Within this manuscript, we present a technical description of a novel US guided approach (combined with EMG) for BoNT injection into the LoCol and LoCap muscles for the management of anterocollis and anterocaput in patients with CD.

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.

Cadaveric study identifying clinical sonoanatomy for proximal and distal approaches of ultrasound-guided intercostobrachial nerve block

2020 ◽  
Vol 45 (11) ◽  
pp. 853-859
Author(s):  
Artid Samerchua ◽  
Prangmalee Leurcharusmee ◽  
Krit Panjasawatwong ◽  
Kittitorn Pansuan ◽  
Pasuk Mahakkanukrauh
Keyword(s):  
Axillary Artery ◽  
Anatomical Variation ◽  
Intercostal Nerve ◽  
Cadaveric Study ◽  
Ultrasound Guided ◽  
Serratus Anterior ◽  
Adjacent Structures ◽  
Intercostobrachial Nerve ◽  
Inferior Border ◽  
Axillary Branches

Background and objectivesThe intercostobrachial nerve (ICBN) has significant anatomical variation. Localization of the ICBN requires an operator’s skill. This cadaveric study aims to describe two simple ultrasound-guided plane blocks of the ICBN when it emerges at the chest wall (proximal approach) and passes through the axillary fossa (distal approach).MethodsThe anatomical relation of the ICBN and adjacent structures was investigated in six fresh cadavers. Thereafter, we described two potential techniques of the ICBN block. The proximal approach was an injection medial to the medial border of the serratus anterior muscle at the inferior border of the second rib. The distal approach was an injection on the surface of the latissimus dorsi muscle at 3–4 cm caudal to the axillary artery. The ultrasound-guided proximal and distal ICBN blocks were performed in seven hemithoraxes and axillary fossae. We recorded dye staining on the ICBN, its branches and clinically correlated structures.ResultsAll ICBNs originated from the second intercostal nerve and 34.6% received a contribution from the first or third intercostal nerve. All ICBNs gave off axillary branches in the axillary fossa and ran towards the posteromedial aspect of the arm. Following the proximal ICBN block, dye stained on 90% of all ICBN’s origins. After the distal ICBN block, all terminal branches and 43% of the axillary branches of the ICBN were stained.ConclusionsThe proximal and distal ICBN blocks, using easily recognized sonoanatomical landmarks, provided consistent dye spread to the ICBN. We encourage further validation of these two techniques in clinical studies.

Ultrasound-Guided Perisutural Botulinum Toxin Injection for Chronic Migraine Headache

2019 ◽  
Vol 98 (8) ◽  
pp. e98-e100 ◽  
Author(s):  
Murat Kara ◽  
Merve Sekizkardeş ◽  
Eda Gürçay ◽  
Ayşen Akinci ◽  
Levent Özçakar
Keyword(s):  
Botulinum Toxin ◽  
Chronic Migraine ◽  
Migraine Headache ◽  
Botulinum Toxin Injection ◽  
Ultrasound Guided

Randomized comparison between interscalene and costoclavicular blocks for arthroscopic shoulder surgery

2019 ◽  
Vol 44 (4) ◽  
pp. 472-477 ◽  
Author(s):  
Julián Aliste ◽  
Daniela Bravo ◽  
Sebastián Layera ◽  
Diego Fernández ◽  
Álvaro Jara ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Side Effects ◽  
Onset Time ◽  
Suprascapular Nerve ◽  
Axillary Nerve ◽  
Shoulder Surgery ◽  
Sensory Function ◽  
Ultrasound Guided ◽  
Pain Scores ◽  
Arthroscopic Shoulder Surgery

BackgroundThis randomized trial compared ultrasound-guided interscalene block (ISB) and costoclavicular brachial plexus block (CCB) for arthroscopic shoulder surgery. We hypothesized that CCB would provide equivalent analgesia to ISB 30 min after surgery without the risk of hemidiaphragmatic paralysis.MethodsAll 44 patients received an ultrasound-guided block of the intermediate cervical plexus. Subsequently, they were randomized to ISB or CCB. The local anesthetic agent (20 mL of levobupivacaine 0.5% and epinephrine 5 µg/mL) and pharmacological block adjunct (4 mg of intravenous dexamethasone) were identical for all study participants. After the block performance, a blinded investigator assessed ISBs and CCBs every 5 min until 30 min using a composite scale that encompassed the sensory function of the supraclavicular nerves, the sensorimotor function of the axillary nerve and the motor function of the suprascapular nerve. A complete block was defined as one displaying a minimal score of six points (out of a maximum of eight points) at 30 min. Onset time was defined as the time required to reach the six-point minimal composite score. The blinded investigator also assessed the presence of hemidiaphragmatic paralysis at 30 min with ultrasonography.Subsequently, all patients underwent general anesthesia. Postoperatively, a blinded investigator recorded pain scores at rest at 0.5, 1, 2, 3, 6, 12, and 24 hours. Patient satisfaction at 24 hours, consumption of intraoperative and postoperative narcotics, and opioid-related side effects (eg, nausea/vomiting, pruritus) were also tabulated.ResultsBoth groups displayed equivalent postoperative pain scores at 0.5, 1, 2, 3, 6, 12, and 24 hours. ISB resulted in a higher incidence of hemidiaphragmatic paralysis (100% vs 0%; P < 0.001) as well as a shorter onset time (14.0 (5.0) vs 21.6 (6.4) minutes; p<0.001). However, no intergroup differences were found in terms of proportion of patients with minimal composite scores of 6 points at 30 min, intraoperative/postoperative opioid consumption, side effects, and patient satisfaction at 24 hours.ConclusionCompared to ISB, CCB results in equivalent postoperative analgesia while circumventing the risk of hemidiaphragmatic paralysis. Further confirmatory trials are required. Future studies should also investigate if CCB can provide surgical anesthesia for arthroscopic shoulder surgery.Clinical Trials RegistrationNCT03411343.

Side effects of botulinum toxin injection for benign anal disorders

2002 ◽  
Vol 14 (8) ◽  
pp. 853-856 ◽  
Author(s):  
Mariusz H. Madaliński ◽  
Jaroslaw Suulawek ◽  
Wojciech Dużyński ◽  
Blazej Zbytek ◽  
Krzysztof Jagieuuluulo ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Side Effects ◽  
Botulinum Toxin Injection ◽  
Anal Disorders

A Comparison of the Short-Term Effects of Ibuprofen and Diclofenac in Spondylosis

1978 ◽  
Vol 6 (5) ◽  
pp. 369-374 ◽  
Author(s):  
W Siegmeth ◽  
W Sieberer
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Active Drug ◽  
Short Term ◽  
Forward Flexion ◽  
Parallel Group ◽  
Pain At Rest ◽  
Drug Free ◽  
Single Blind ◽  
Spinal Flexion

In this controlled, single-blind parallel group study, the effect of ibuprofen 1200 mg daily was compared with diclofenac 75 mg daily. Thirty patients entered the study, randomized into two groups, each group receiving one tablet three times daily for two weeks. A one-week wash-out period (i.e. a drug-free period during which only physiotherapy was given), preceded and followed the treatment on active drug. Assessments were made by the same clinician throughout who was unaware of the treatment of individual patients. Statistically significant improvement was shown by patients receiving ibuprofen for the degree of pain relief at rest and improvement was also shown for the degree of pain at rest and during exercise, for pain relief during exercise and for spinal flexion. Patients who received diclofenac showed stastistically significant improvement for forward flexion, together with improvement for the degree of pain on exercise. Side-effects were very few.

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