Abstract
The visualization of the human body has frequently been groundbreaking in medicine. In the last few years, the use of ultrasound (US) imaging has become a well-established procedure for botulinum toxin therapy in people with cervical dystonia (CD). It is now undisputed among experts that some of the most relevant muscles in this indication can be safely injected under visual US guidance. This review will explore the method from basic technical considerations, current evidence to conceptual developments of the phenomenology of cervical dystonia. We will review the implications of introducing US to our understanding of muscle function and anatomy of common cervical dystonic patterns. We suggest a flow chart for the use of US to achieve a personalized treatment of people with CD. Thus, we hope to contribute a resource that is useful in clinical practice and that stimulates the ongoing development of this valuable technique.
Highlights
Ever since a number of high-quality clinical trials have shown excellent safety and superior efficacy, precisely performed and dose-adequate intramuscular injections of botulinum neurotoxin serotype A (BoNT/A) have been the first-line treatment for cervical dystonia (CD), without any effective alternative [1].From the beginning of the BoNT/A therapy in CD in the 1980s, these injections have been executed by movement disorder experts who have been trained to be highly familiar with the anatomy of the human cervical region, even in the case of dystonic alterations of muscle size and head position
We introduce the reader to the application of US by raising awareness of the technique’s potential, reviewing key technical details and relevant aspects of neck anatomy, illustrating explanations with state-of-the-art images of the muscles of the neck, and providing an overview of the current sparse scientific literature
We expect that the use of US in clinical trials will contribute to better standardization and higher quality of research
Summary
Ever since a number of high-quality clinical trials have shown excellent safety and superior efficacy, precisely performed and dose-adequate intramuscular injections of botulinum neurotoxin serotype A (BoNT/A) have been the first-line treatment for cervical dystonia (CD), without any effective alternative [1]. Visualizing the muscles of the neck by examining cervical computed tomographies, Gerhard Reichel and his team developed a novel classification system for CD that he termed the ColCap-concept, to encompass the large variety of clinical patterns he had observed [6,7] They suggested that the complex cervical spine with its seven vertebrae could be reduced to two main functional units. We suggest using US-guided EMG for complex patterns of CD, as only such a combined approach achieves to match precise topographical with pathognomonic functional information that is necessary to characterize the individual dystonic pattern To this end, we introduce the reader to the application of US by raising awareness of the technique’s potential, reviewing key technical details and relevant aspects of neck anatomy, illustrating explanations with state-of-the-art images of the muscles of the neck, and providing an overview of the current sparse scientific literature. We suggest a stepwise workflow to visualize the role of US for the personalized treatment of CD, and report four illustrative clinical cases
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