Оптимизация диагностики и лечения цервикальной дистонии

Abstract

The purpose is to optimize diagnostics of cervical dystonia using multispiral computed tomography (MSCT) of the cervical spine to improve the results of botulinum toxin therapy. Material and methods. 27 patients diagnosed with the idiopathic CD (21 females among them) were examined. The age of patients ranged from 25 to 72 years old (the average age was 40 (3,3)). All the patients were scanned with 3D multispiral computed tomography (MSCT) of the cervical spine in order to verify the dystonic muscles and determine the degree of head and neck rotation. MSCT helped to identify the cervical spine deformation, the level of its displacement and the state of dystonic muscles. The Tsui et al. rating scale was used for assessing the severity of CD before and after the treatment. Also the intensity of pain syndrome was assessed according to the visual analogue scale (VAS) before and after the treatment. All the patients had injections of botulinum toxin type A, in the dose 200–300 U. The time period between the injections was 3,5–4 months. Results. The study revealed that women tend to have cervical dystonia more often (77,8%). Late diagnostics of the disease still remains. The duration of the disease lasted from 1 month to 18 years. Before the treatment the pain syndrome intensity amounted to 5,6 (0,8) points, according to VAS, whereas after the treatment it was 1,9 (0,8) points. The 3D MSCT revealed the deformation of the cervical spine. MSCT helped to verify the dystonic muscles (a bigger surface of the dystonic muscle in comparison with the healthy part, a more «round» image of the muscle). MSCT of the cervical spine enabled to verify the form of dystonia (caput, collis or their combination). Conclusions. Late diagnostics of CD remains. Botulinum toxin therapy is a highly effective way of CD treatment. The efficiency of the botulinum toxin therapy in the given category of patients depends on the right choice of target muscles, the verification of the form of CD and adherence to the early treatment principle.