Management of Anterocapitis and Anterocollis: A Novel Ultrasound Guided Approach Combined with Electromyography for Botulinum Toxin Injection of Longus Colli and Longus Capitis
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作者:
Farrell, Michael
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机构:
MedStar Georgetown Univ, Natl Rehabil Hosp, Washington, DC 20010 USAMedStar Georgetown Univ, Natl Rehabil Hosp, Washington, DC 20010 USA
Farrell, Michael
[1
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Karp, Barbara I.
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NINDS, Bldg 36,Rm 4D04, Bethesda, MD 20892 USAMedStar Georgetown Univ, Natl Rehabil Hosp, Washington, DC 20010 USA
Karp, Barbara I.
[2
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Kassavetis, Panagiotis
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NINDS, Bldg 36,Rm 4D04, Bethesda, MD 20892 USAMedStar Georgetown Univ, Natl Rehabil Hosp, Washington, DC 20010 USA
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.
机构:
London North West Univ Healthcare NHS Trust, Reg Hyperacute Rehabil Unit, London, England
Kings Coll London, Dept Palliat Care, London, EnglandLondon North West Univ Healthcare NHS Trust, Reg Hyperacute Rehabil Unit, London, England
Ashford, Stephen A.
Morris, Gary
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机构:
Cardiff Univ, Sch Healthcare Sci, Heath Pk Campus, Cardiff CF14 4XN, Wales
Hywel Dda Univ Hlth Board, Carmarthen, WalesLondon North West Univ Healthcare NHS Trust, Reg Hyperacute Rehabil Unit, London, England
Morris, Gary
Smith, Michael J.
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Cardiff Univ, Sch Healthcare Sci, Heath Pk Campus, Cardiff CF14 4XN, WalesLondon North West Univ Healthcare NHS Trust, Reg Hyperacute Rehabil Unit, London, England
机构:
Department of Gastroenterology, SMS Medical College and Hospital, House No. 109, Shiv Vihar Infront of Road No 5, VKI Sikar Road, JaipurDepartment of Gastroenterology, SMS Medical College and Hospital, House No. 109, Shiv Vihar Infront of Road No 5, VKI Sikar Road, Jaipur
Jhajharia A.
Wanjari S.
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Department of Gastroenterology, SMS Medical College and Hospital, House No. 109, Shiv Vihar Infront of Road No 5, VKI Sikar Road, JaipurDepartment of Gastroenterology, SMS Medical College and Hospital, House No. 109, Shiv Vihar Infront of Road No 5, VKI Sikar Road, Jaipur
Wanjari S.
Ashdhir P.
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Department of Gastroenterology, SMS Medical College and Hospital, House No. 109, Shiv Vihar Infront of Road No 5, VKI Sikar Road, JaipurDepartment of Gastroenterology, SMS Medical College and Hospital, House No. 109, Shiv Vihar Infront of Road No 5, VKI Sikar Road, Jaipur
Ashdhir P.
Sharma D.
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机构:
Department of Gastroenterology, SMS Medical College and Hospital, House No. 109, Shiv Vihar Infront of Road No 5, VKI Sikar Road, JaipurDepartment of Gastroenterology, SMS Medical College and Hospital, House No. 109, Shiv Vihar Infront of Road No 5, VKI Sikar Road, Jaipur
Sharma D.
Pokharna R.
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机构:
Department of Gastroenterology, SMS Medical College and Hospital, House No. 109, Shiv Vihar Infront of Road No 5, VKI Sikar Road, JaipurDepartment of Gastroenterology, SMS Medical College and Hospital, House No. 109, Shiv Vihar Infront of Road No 5, VKI Sikar Road, Jaipur
Pokharna R.
Nijhawan S.
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机构:
Department of Gastroenterology, SMS Medical College and Hospital, House No. 109, Shiv Vihar Infront of Road No 5, VKI Sikar Road, JaipurDepartment of Gastroenterology, SMS Medical College and Hospital, House No. 109, Shiv Vihar Infront of Road No 5, VKI Sikar Road, Jaipur