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Management of Anterocapitis and Anterocollis: A Novel Ultrasound Guided Approach Combined with Electromyography for Botulinum Toxin Injection of Longus Colli and Longus Capitis

1
MedStar/Georgetown University National Rehabilitation Hospital, Washington, DC 20010, USA
2
National Institutes of Neurological Disorders and Stroke, Bethesda, MD 20892 USA
3
Emory School of Medicine, Emory University, Atlanta, GA 30322, USA
4
Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, MD 20892-1604, USA
5
Functional and Applied Biomechanics Section, Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, MD 20892-1604, USA
*
Author to whom correspondence should be addressed.
Toxins 2020, 12(10), 626; https://doi.org/10.3390/toxins12100626
Received: 29 August 2020 / Revised: 24 September 2020 / Accepted: 27 September 2020 / Published: 30 September 2020
(This article belongs to the Special Issue Movement Disorders and Therapeutic Applications of Botulinum Toxin)
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. View Full-Text
Keywords: cervical dystonia; botulinum toxins; anterocaput; anterocollis; injection technique; longus colli; longus capitis; ultrasound guidance; head and neck; chemodenervation cervical dystonia; botulinum toxins; anterocaput; anterocollis; injection technique; longus colli; longus capitis; ultrasound guidance; head and neck; chemodenervation
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MDPI and ACS Style

Farrell, M.; Karp, B.I.; Kassavetis, P.; Berrigan, W.; Yonter, S.; Ehrlich, D.; Alter, K.E. Management of Anterocapitis and Anterocollis: A Novel Ultrasound Guided Approach Combined with Electromyography for Botulinum Toxin Injection of Longus Colli and Longus Capitis. Toxins 2020, 12, 626. https://doi.org/10.3390/toxins12100626

AMA Style

Farrell M, Karp BI, Kassavetis P, Berrigan W, Yonter S, Ehrlich D, Alter KE. Management of Anterocapitis and Anterocollis: A Novel Ultrasound Guided Approach Combined with Electromyography for Botulinum Toxin Injection of Longus Colli and Longus Capitis. Toxins. 2020; 12(10):626. https://doi.org/10.3390/toxins12100626

Chicago/Turabian Style

Farrell, Michael; Karp, Barbara I.; Kassavetis, Panagiotis; Berrigan, William; Yonter, Simge; Ehrlich, Debra; Alter, Katharine E. 2020. "Management of Anterocapitis and Anterocollis: A Novel Ultrasound Guided Approach Combined with Electromyography for Botulinum Toxin Injection of Longus Colli and Longus Capitis" Toxins 12, no. 10: 626. https://doi.org/10.3390/toxins12100626

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