Botulinum Toxin Type a in Cervical Dystonia

Abstract

Cervical dystonia is a syndrome characterized by anomalous postures and unintentional repetitive movements of the head and the neck. Aim of this study is to show the effectiveness of the combined treatment botulinum toxin-FKT through the use of a recent methodic of investigation, myoton, and of the classical clinical evaluations, such as Tsui and VASscales. 15 patients (9 females, 6 males) have been selected. During the initial visit and in the following controls, performed every month, patients have been submitted to physiatric examination, clinical evaluation of the dystonia through the Tsui scale, clinical evaluation of the pain through the VAS scale, myometric evaluation. We obtained statistically reduction of muscular tone's value in passive elongation (to=16,34±1,23) until 4 month (t4 =16,1l±1,23), when we performed a second infiltration. After 4 months from the second infiltration (t8=15,99±1,1l) value did not present more some statistical correlation and was necessary to perform a new infiltration. Values of elasticity, stiffness, Tsui and VASscale followed the same course ofthe tone. Our study demonstrates that combined treatment botulinum toxin-FKT is effective. It emerges that if to the treatment with botulinum toxin follows a suitable FKT treatment, the effect of the drug lasts 4 months and not 3 months as described by the literature. Our study has underlined that using myometric measurement we can consider least changes in muscular tone, elasticity and stiffness; we have a broader view of the spastic muscle, and we can better plan appropriate rehabilitative care for each patient.Cervical dystonia is a syndrome characterized by anomalous postures and unintentional repetitive movements of the head and the neck. It develops through:1. contemporary contraction of agonist and antagonists muscles; 2. reduction of the motor control inhibiting mechanisms; 3. alteration of the afferences from basal ganglia Pl. In relationship to the posture of the head and the neck four types of cervical dystonia are recognized: torticollis (head and neck are rotated in hourly sense or counterclockwise), 1aterocollis (head tilted on the shoulder), retrocollis (turned head to the back with the nape toward the shoulders) or anterocollis (turned head in ahead with the chin toward the sternum). It is often associated with other types of diystonia (oro-mandibular, blepharospasm, axial or hand dystonia) and / or postural tremor. Symptoms increase by the work, the stress and the motor activity; they decrease by the postural changes and the rest. From different years, therapy with botulinum toxin has radically modified the functional prognosis ofthe cervical dystonia; it become the first-quality treatment [2]. The effectiveness of the treatment is tied up to the correct identification of the muscles and the suitable dosing of toxin to inject. The identification of the muscles depends on the posture of the head and neck. Torticollis is mainly sustained by the contralateral sternocleidomastoid muscle (SCM) and ipsilateral splenius m...

Reduced Neck Muscle Strength and Altered Muscle Mechanical Properties in Cervical Dystonia Following Botulinum Neurotoxin Injections: A Prospective Study

“…Muscle tension and stiffness values decreased at four weeks after BoNT injections, and elasticity values increased at eight weeks after BoNT injections. The results of the present study are somewhat similar to the results reported by Marvulli et al [ 8 ], who combined BoNT injections and physiotherapy for the treatment of CD in 15 patients. They performed clinical evaluation and myotonometric measurements using the Myoton-3 before and at one, two, and three months following BoNT injections.…”

“…However, the differences in study designs between that study and the present study may partly explain the differences in results. Patients in the present study had been receiving BoNT injections for years, whereas patients in the study of Marvulli et al [ 8 ] received their first BoNT injections. It has been reported that long-term use of BoNT results in a decrease in contractile tissue and an increase in connective tissue [ 15 ], thus making the muscle more rigid.…”

“…Objective strength measurements may help identify patients with neck weakness after BoNT injections that causes difficulties in daily living and therefore need additional strength training. Additionally, even though CD patients have frequent complaints of neck tension, only one study [ 8 ] has provided quantitative data about the effects of initial BoNT injections on the passive mechanical properties of skeletal muscle in a clinical setting, despite that measurement devices have been developed for this purpose. Myotonometers may provide an objective, non-invasive tool to quantify changes in muscle properties after BoNT injections that were previously obtained using subjective methods.…”

Beyond Typical Ataxia Telangiectasia: How to Identify the Ataxia Telangiectasia‐Like Disorders

“…Botulinum toxin is the first-choice treatment for focal dystonia. 10,36,37 Some studies have showed improvement of dystonia with the use of levodopa in both, ATLD and AT. 20,38 Oral drugs therapy with anticholinergic drugs (eg biperiden and trihexyphenidyl) 10,37 and GABA (c-aminobutyric acid) mimetics (eg baclofen, clonazepam) may alleviate symptoms in patients with generalized dystonia, blepharospasm, pain and oromandibular dystonia.…”

“…Some drugs may be useful in the management of symptoms. Botulinum toxin is the first‐choice treatment for focal dystonia 10,36,37 . Some studies have showed improvement of dystonia with the use of levodopa in both, ATLD and AT 20,38 .…”