Management of Anterocapitis and Anterocollis: A Novel Ultrasound Guided Approach Combined with Electromyography for Botulinum Toxin Injection of Longus Colli and Longus Capitis
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...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-09-01
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| Series: | Toxins |
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| Online Access: | https://www.mdpi.com/2072-6651/12/10/626 |
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| author | Michael Farrell Barbara I. Karp Panagiotis Kassavetis William Berrigan Simge Yonter Debra Ehrlich Katharine E. Alter |
| author_facet | Michael Farrell Barbara I. Karp Panagiotis Kassavetis William Berrigan Simge Yonter Debra Ehrlich Katharine E. Alter |
| author_sort | Michael Farrell |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-10T15:55:46Z |
| format | Article |
| id | doaj.art-46a1a5670d194441ae2c306dfd07815e |
| institution | Directory Open Access Journal |
| issn | 2072-6651 |
| language | English |
| last_indexed | 2024-03-10T15:55:46Z |
| publishDate | 2020-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Toxins |
| spelling | doaj.art-46a1a5670d194441ae2c306dfd07815e2023-11-20T15:40:58ZengMDPI AGToxins2072-66512020-09-01121062610.3390/toxins12100626Management of Anterocapitis and Anterocollis: A Novel Ultrasound Guided Approach Combined with Electromyography for Botulinum Toxin Injection of Longus Colli and Longus CapitisMichael Farrell0Barbara I. Karp1Panagiotis Kassavetis2William Berrigan3Simge Yonter4Debra Ehrlich5Katharine E. Alter6MedStar/Georgetown University National Rehabilitation Hospital, Washington, DC 20010, USANational Institutes of Neurological Disorders and Stroke, Bethesda, MD 20892 USANational Institutes of Neurological Disorders and Stroke, Bethesda, MD 20892 USAEmory School of Medicine, Emory University, Atlanta, GA 30322, USARehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, MD 20892-1604, USANational Institutes of Neurological Disorders and Stroke, Bethesda, MD 20892 USAFunctional and Applied Biomechanics Section, Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, MD 20892-1604, USAChemodenervation 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.https://www.mdpi.com/2072-6651/12/10/626cervical dystoniabotulinum toxinsanterocaputanterocollisinjection techniquelongus colli |
| spellingShingle | Michael Farrell Barbara I. Karp Panagiotis Kassavetis William Berrigan Simge Yonter Debra Ehrlich Katharine E. Alter Management of Anterocapitis and Anterocollis: A Novel Ultrasound Guided Approach Combined with Electromyography for Botulinum Toxin Injection of Longus Colli and Longus Capitis Toxins cervical dystonia botulinum toxins anterocaput anterocollis injection technique longus colli |
| title | Management of Anterocapitis and Anterocollis: A Novel Ultrasound Guided Approach Combined with Electromyography for Botulinum Toxin Injection of Longus Colli and Longus Capitis |
| title_full | Management of Anterocapitis and Anterocollis: A Novel Ultrasound Guided Approach Combined with Electromyography for Botulinum Toxin Injection of Longus Colli and Longus Capitis |
| title_fullStr | Management of Anterocapitis and Anterocollis: A Novel Ultrasound Guided Approach Combined with Electromyography for Botulinum Toxin Injection of Longus Colli and Longus Capitis |
| title_full_unstemmed | Management of Anterocapitis and Anterocollis: A Novel Ultrasound Guided Approach Combined with Electromyography for Botulinum Toxin Injection of Longus Colli and Longus Capitis |
| title_short | Management of Anterocapitis and Anterocollis: A Novel Ultrasound Guided Approach Combined with Electromyography for Botulinum Toxin Injection of Longus Colli and Longus Capitis |
| title_sort | management of anterocapitis and anterocollis a novel ultrasound guided approach combined with electromyography for botulinum toxin injection of longus colli and longus capitis |
| topic | cervical dystonia botulinum toxins anterocaput anterocollis injection technique longus colli |
| url | https://www.mdpi.com/2072-6651/12/10/626 |
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