Ultrasound‐guided botulinum toxin therapy for deep muscles in cervical dystonia

Abstract

AbstractBotulinum toxin (BoNT) injection is the established first line of treatment for cervical dystonia, and the accurate injection into target muscles is of paramount importance to improve the treatment outcome. To this purpose, guided injections with the electromyography or the ultrasound (US) are commonly utilized. The current review provides personally invented US‐guided procedures to approach the obliquus capitis inferior (OCI), the semispinalis cervicis, the longissimus capitis, and the rectus capitis posterior major muscles for BoNT injection. Among them the OCI is particularly important because it is a strong head rotator and is an essential target for rotatocollis. The OCI is also involved in no‐no type of dystonic tremor and jaw protrusion (sagittal shift) and should be dealt with as a target of treatment in the routine practice. The US‐guided muscle identification followed by BoNT injection is a fundamental technique particularly for deep cervical muscles. As for the rectus capitis posterior major muscle, however, its demonstration technique with the US seems challenging.