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Liu B, Xu J, Yang H, Yu X, Mao Z. PAllidal versus SubThalamic deep brain Stimulation for Cervical Dystonia (PASTS-CD): study protocol for a multicentre randomised controlled trial. BMJ Open 2023; 13:e073425. [PMID: 37832982 PMCID: PMC10582967 DOI: 10.1136/bmjopen-2023-073425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Deep brain stimulation (DBS) has been validated as a safe and effective treatment for refractory cervical dystonia (CD). Globus pallidus internus (GPi) and subthalamic nucleus (STN) are the two main stimulating targets. However, there has been no prospective study to clarify which target is the better DBS candidate for CD. The objective of this trial is to compare directly the efficacy and safety of GPi-DBS and STN-DBS, thereby instructing the selection of DBS target in clinical practice. METHODS AND ANALYSIS This multicentre, prospective, randomised, controlled study plans to enrol 98 refractory CD patients. Eligible CD patients will be randomly allocated to GPi-DBS group or STN-DBS group, with the DBS electrodes implanted into the posteroventral portion of GPi or the dorsolateral portion of STN, respectively. The primary outcome will be the improvement of symptomatic severity, measured by the changes in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) severity subscale and the Tsui scale at 3 months, 6 months and 12 months after surgery. The secondary outcomes include the improvement of the TWSTRS-disability subscale, TWSTRS-pain subscale, quality of life, mental and cognitive condition, as well as the differences in stimulation parameters and adverse effects. In addition, this study intends to identify certain predictors of DBS efficacy for CD. ETHICS AND DISSEMINATION The trial has been approved by the Medical Ethics Committee of Chinese PLA General Hospital (S2022-613-01). The results of this study will be published in international peer-reviewed journals and shared in professional medical conferences. TRIAL REGISTRATION NUMBER NCT05715138.
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Affiliation(s)
- Bin Liu
- Medical School, Chinese PLA General Hospital, Beijing, China
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Junpeng Xu
- Medical School, Chinese PLA General Hospital, Beijing, China
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Haonan Yang
- Medical School, Chinese PLA General Hospital, Beijing, China
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xinguang Yu
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhiqi Mao
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
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Opara J. Is There a Standard Rehabilitation Procedure in Cervical Dystonia? REHABILITACJA MEDYCZNA 2023. [DOI: 10.5604/01.3001.0016.3419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Introduction: Idiopathic cervical dystonia, also known as spasmodic torticollis, is the most common form of focal dystonia in adults. Cervical dystonia usually appears between the ages of 30 and 50, twice as often in women, and is characterised by uncontrollable painful contractions of the sternocleidomastoid muscle, which results in misalignment of the head and shoulder. Over time, the disease becomes very burdensome for the patient and reduces his/her independence and quality of life; falls happen.Aim: The aim of the article is to present the current state of knowledge on comprehensive rehabilitation in cervical dystonia. Data on the prevalence, symptoms, diagnosis, clinical assessment, pharmacological treatment (including the most commonly used botulinum toxin), neurosurgical treatment and comprehensive rehabilitation are presented.Methods: The applied methods was a narrative critical review of scientific reports.Results: Out of several hundred publications, works worthy of particular attention were selected. In them, are described of conducting exercises, the main goal of which is to stretch and relax the dystonic muscles while strengthening the antagonistic muscles and correcting the position of the head. The selected authors used manual therapy, exercises at the patient's home, EMG biofeedback, magnetic stimulation of the cerebellum, vibration of the neck muscles, functional electrostimulation (FES) of antagonistic muscles, mobilisation of the cervical spine, postural exercises, isometric exercises, muscle relaxation, the PNF method, relaxation training, balance exercises, coordination, corrective exercises, massage, relaxation exercises, stretching and kinesiotaping.Conclusions: The variety of disease forms (10 head positioning patterns are described) and different severity of symptoms make it impossible to draw up a scheme of rehabilitation. In each case, rehabilitation must be tailored individually, and the physiotherapist taking care of the patient should have extensive experience. Physiotherapy can alleviate the disability caused by dystonia, however, due to the many non-motor symptoms, a holistic approach to the patient should also be kept in mind.
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Affiliation(s)
- Józef Opara
- Faculty of Physiotherapy, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
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Byrd JJ, McCumber TL, Snow EL. Cadaveric case report and biomechanical analysis of an accessory clavicular head to the sternocleidomastoid. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Dec-Ćwiek M, Porębska K, Sawczyńska K, Kubala M, Witkowska M, Zmijewska K, Antczak J, Pera J. KinesioTaping after botulinum toxin type A for cervical dystonia in adult patients. Brain Behav 2022; 12:e2541. [PMID: 35238494 PMCID: PMC9014990 DOI: 10.1002/brb3.2541] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/08/2022] [Accepted: 02/13/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Studies explored physiotherapeutic approaches in cervical dystonia (CD) patients with or without botulinum toxin (BoNT) injections, however the results are varying. There are no clinical trials investigating the effects of kinesiology taping in CD patients. The objective of this study is to investigate the efficacy of kinesiology taping as an adjunct to the BoNT injections in patients with CD. METHODS Twenty-five patients were enrolled to the study. Patients were randomly assigned to the experimental 1 (BoNT + KinesioTaping), experimental 2 (BoNT + ShamTaping) or control (BoNT) treatment. After 12 weeks they were moved to the next experimental group and finally every patient received all 3 proposed treatment options. The severity of CD was quantified with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) including Torticollis severity, Disability, and Pain scales. Quality of life was evaluated using Craniocervical dystonia questionnaire (CDQ4). RESULTS In all treatment groups, there was a significant improvement in dystonia symptoms measured with TWSTRS (total score) after BoNT injection regardless of the allocation to the experimental treatment (p < .05). ANOVA analysis revealed no differences in any of the TWSTRS variables after the intervention. Quality of life was significantly improved after application of taping (p < .05, p = .03). CONCLUSIONS Application of KinesioTaping after BoNT injection provided no additional effect on the severity of dystonia, although the quality of life was improved in patients with CD. Further research investigating the effect of KinesioTaping prior to BoNT injection is required.
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Affiliation(s)
- Małgorzata Dec-Ćwiek
- Department of Neurology, Medical College, Jagiellonian University, Krakow, Poland
| | - Karolina Porębska
- Department of Neurology, Medical College, Jagiellonian University, Krakow, Poland
| | - Katarzyna Sawczyńska
- Department of Neurology, Medical College, Jagiellonian University, Krakow, Poland
| | - Marcin Kubala
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Magdalena Witkowska
- Department of Neurology, Medical College, Jagiellonian University, Krakow, Poland
| | - Kinga Zmijewska
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland.,Department of Orthopedics and Physiotherapy, Medical College, Jagiellonian University, Krakow, Poland
| | - Jakub Antczak
- Department of Neurology, Medical College, Jagiellonian University, Krakow, Poland
| | - Joanna Pera
- Department of Neurology, Medical College, Jagiellonian University, Krakow, Poland
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Srinivasaiah B, Venkataramaiah S, Kondavagilu Ramaprasannakumar S, Naik SS. Letter to the Editor Regarding "Cervical Myeloradiculopathy and Atlantoaxial Instability in Cervical Dystonia". World Neurosurg 2021; 157:262. [PMID: 34929782 DOI: 10.1016/j.wneu.2021.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | - Shweta S Naik
- Department of Neuroanesthesia, NIMHANS, Bangalore, India
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Naik AG, Ezana D, Cannard G, Mitchell N, Tomaras M, Meystedt JC, Sayce L, Charles D, Hacker ML. Exploring the presence of multiple abnormal non-motor features in patients with cervical dystonia. J Clin Neurosci 2021; 94:315-320. [PMID: 34863456 DOI: 10.1016/j.jocn.2021.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/06/2021] [Accepted: 10/24/2021] [Indexed: 11/27/2022]
Abstract
This study's aim was to investigate prevalence of four non-motor symptoms in patients with cervical dystonia and healthy controls to explore whether the presence of multiple non-motor features is associated with cervical dystonia diagnosis. Fifteen patients with cervical dystonia and 15 healthy controls underwent non-invasive testing of spatial discrimination threshold, temporal discrimination threshold, vibration-induced illusion of movement, and kinesthesia. All spatial discrimination threshold, temporal discrimination threshold, and vibration-induced illusion of movement measures were converted to standardized Z scores with scores >2.0 considered abnormal. Any incorrect kinesthesia response was considered abnormal. Prevalence of each abnormal non-motor feature was compared between groups using a chi-squared test. A higher proportion of patients with cervical dystonia had abnormal spatial discrimination threshold (p = 0.01) and abnormal kinesthesia (p = 0.03) scores compared to healthy control subjects. There were no significant differences between the proportion of patients with cervical dystonia versus healthy controls for abnormal temporal discrimination threshold (p = 0.07) or abnormal vibration-induced illusion of movement (p = 0.14). Forty-seven percent of patients with cervical dystonia (7/15) demonstrated one abnormal non-motor feature, 20% (3/15) displayed two abnormal features, and 13% (2/15) displayed three abnormal features. Kinesthesia was the only non-motor feature identified as abnormal in the control group (20%, 3/15). All four tests demonstrated high specificity (80-100%) and low-moderate sensitivity (13-60%). These findings suggest that non-motor feature testing, specifically for spatial discrimination threshold and kinesthesia, could be a highly specific diagnostic tool to inform cervical dystonia diagnosis. Further investigation is needed to confirm these findings.
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Affiliation(s)
- Aaditi G Naik
- Department of Neurology, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville TN 37232, USA; Pritzker School of Medicine, University of Chicago, 924 E. 57(th) St, Chicago, IL 60637, USA.
| | - David Ezana
- Department of Neurology, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville TN 37232, USA.
| | - Grace Cannard
- Department of Neurology, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville TN 37232, USA; Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112, USA.
| | - Nia Mitchell
- Department of Neurology, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville TN 37232, USA.
| | - Miranda Tomaras
- Department of Neurology, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville TN 37232, USA.
| | - Jacqueline C Meystedt
- Department of Neurology, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville TN 37232, USA.
| | - Lea Sayce
- Department of Neurology, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville TN 37232, USA; Department of Communication Science and Disorders, University of Pittsburgh School of Health and Rehabilitation Sciences, 5035 Forbes Tower, Pittsburgh, PA 15260, USA.
| | - David Charles
- Department of Neurology, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville TN 37232, USA.
| | - Mallory L Hacker
- Department of Neurology, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville TN 37232, USA; Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA.
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Pain in focal dystonias – A focused review to address an important component of the disease. Parkinsonism Relat Disord 2018; 54:17-24. [DOI: 10.1016/j.parkreldis.2018.04.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 04/05/2018] [Accepted: 04/26/2018] [Indexed: 12/16/2022]
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Validation of Fear of Falling and Balance Confidence Assessment Scales in Persons With Dystonia. J Neurol Phys Ther 2018; 41:239-244. [PMID: 28922315 DOI: 10.1097/npt.0000000000000198] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Falls are problematic for people living with neurological disorders and a fear of falling can impact on actual falls. Fear of falling is commonly assessed using the Falls Self-Efficacy Scale International (FES-I) or the Activities-specific Balance Confidence (ABC) Scale. These scales can predict risk of falling. We aimed to validate the FES-I and the ABC in persons with dystonia. METHODS We conducted an online survey of people with dystonia, collecting information on demographics, 6-month falls history, dystonia disability, and the FES-I and ABC scales. Scales were validated for structural validity and internal consistency. We also examined goodness-of-fit, convergent validity, and predictive validity, and determined cutoff scores for predicting falls risk. RESULTS Survey responses (n = 122) showed that both FES-I and ABC scales have high internal validity and convergent validity with the Functional Disability Questionnaire in persons with dystonia. Each scale examines a single factor, fear of falling (FES-I) and balance confidence (ABC). At least one fall was reported by 39% of participants; the cutoff value for falls risk was found to be 29.5 and 71.3 for the FES-I and the ABC respectively. DISCUSSION AND CONCLUSIONS The FES-I and the ABC scales are valid scales to examine fear of falling and balance confidence in persons with dystonia. Fear of falling is high and balance confidence is low and both are worse in those with dystonia who have previously fallen.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A182).
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Isabel Useros-Olmo A, Martínez-Pernía D, Huepe D. The effects of a relaxation program featuring aquatic therapy and autogenic training among people with cervical dystonia (a pilot study). Physiother Theory Pract 2018; 36:488-497. [PMID: 29939827 DOI: 10.1080/09593985.2018.1488319] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Classic physical interventions for cervical dystonia (CD) have focused on treating motor components or, on motor components and relaxation programs. However, no CD treatment study has focused on a relaxation program alone. We developed a pilot study to assess whether a therapy completely based on a relaxation program could improve the physical and mental symptomatologies of patients with CD. Fifteen persons were included in the experimental group, which received individual sessions of aquatic (Watsu) therapy (WT) and autogenic training (AT). In addition, 12 persons were included in passive control group. We administered different questionnaires related to quality of life (SF-36), pain (Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and Visual Analog Scale (VAS)) and mood (Beck Depression Inventory (BDI-II) and State-Trait Anxiety Inventory (STAI)). A significant interaction was observed between treatment and time with regard to the SF-36, VAS, and TWSTRS within the experimental group (p < 0.01). The BDI-II showed depression decrease as a simple effect (p < 0.05), and the STAI did not change. No effects were found with regard to the control group. In this exploratory study, we found that a therapy based on whole body relaxation improved the symptoms of patients with CD. This knowledge enables a disease-management strategy that uses a holistic perspective and moves beyond the dystonic focus.
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Affiliation(s)
- Ana Isabel Useros-Olmo
- Department of Physiotherapy, Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Unidad de Daño Cerebral. Hospital Beata María Ana, Madrid, Spain
| | - David Martínez-Pernía
- Center for Social and Cognitive Neuroscience(CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile.,Laboratorio de Neuropsicología y Neurociencias Clínicas (LANNEC), Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile.,Clínica de Memoria y Neuropsiquiatría (CMYN), Servicio de Neurología. Hospital del Salvador y Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - David Huepe
- Center for Social and Cognitive Neuroscience(CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
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Bradley B, Haladay D. The effects of a laser-guided postural reeducation program on pain, neck active range of motion, and functional improvement in a 75-year-old patient with cervical dystonia. Physiother Theory Pract 2018; 36:550-557. [PMID: 29939800 DOI: 10.1080/09593985.2018.1488904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background and Purpose: Limited research exists regarding physical therapy management for patients with cervical dystonia (CD). The purpose of this case report is to describe the clinical management of a patient with CD using manual techniques, cervical traction, and laser-guided postural reeducation. Case Description: The patient was a 75-year-old female with CD, diagnosed 40 years prior, with a 10-year history of botulinum neurotoxin injections. She reported a 1-year history of worsening neck pain and cervical range of motion loss which was significantly affecting her ability to sleep and drive. The patient was seen for 12 visits over a 6-week period. Outcomes: Discharge scores indicated marked improvements in active range of motion, neck disability index, and the CDIP-58 questionnaire. Improvement in motor control as measured during the SenMorCor™ Laser Functional Error Assessment was demonstrated in the motions of "looking right" (53%) and up (48%). Discussion: This case report indicates that a physical therapy program consisting of a daily laser-guided home program for head postural reeducation in conjunction with classic physical therapy techniques may be an option for patients with CD; however, further research is needed prior to adoption of these techniques as standard of care for patients with CD.
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Affiliation(s)
- Brent Bradley
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT, USA.,Country for University of South Florida, USA
| | - Douglas Haladay
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT, USA
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Barr C, Barnard R, Edwards L, Lennon S, Bradnam L. Impairments of balance, stepping reactions and gait in people with cervical dystonia. Gait Posture 2017; 55:55-61. [PMID: 28412603 DOI: 10.1016/j.gaitpost.2017.04.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 02/23/2017] [Accepted: 04/02/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Impaired balance is common in neurological disorders. Cervical dystonia is a neurological movement disorder affecting the neck. The effect of this aberrant head posture on physical function is unknown. OBJECTIVES To compare balance, mobility, gait and stepping reactions between ten people with cervical dystonia and ten control adults. METHODS Spatiotemporal gait parameters and walking speed were assessed using a computerised walkway. Step length and time, time in double support and gait variability were calculated, then normalised to gait speed. Centre of pressure path length was assessed with eyes open and eyes closed to calculate a Romberg Quotient. Simple and choice reaction times were measured using customised apparatus while mobility was assessed by the timed up and go. Cervical spine range of motion was measured using a head mounted goniometer. Self-reported scales included Falls Self Efficacy Scale and Dystonia Discomfort Scale. RESULTS There was a difference between groups for most outcome measures. The timed up-and-go and walking speed was slower (both P<0.005) and the Romberg Quotient lower (P=0.046) in cervical dystonia. People with cervical dystonia had lower falls self-efficacy (P=0.0002). Reduced cervical range of motion was correlated with balance, stepping reaction time and mobility (all P<0.05). Timed up and go was positively associated with stepping reaction time (P<0.01). Dystonia discomfort did not impact function. CONCLUSIONS People with cervical dystonia displayed deficits in balance, gait and stepping reactions, and expressed higher fear of falling. Studies to further elucidate functional limitations and their impact on activity and participation in daily life are required.
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Affiliation(s)
- Christopher Barr
- Clinical Rehabilitation, School of Health Sciences, Flinders University, Australia
| | - Rhiannon Barnard
- Discipline of Physiotherapy, School of Health Sciences, Flinders University, Australia
| | - Lauren Edwards
- Discipline of Physiotherapy, School of Health Sciences, Flinders University, Australia
| | - Sheila Lennon
- Discipline of Physiotherapy, School of Health Sciences, Flinders University, Australia
| | - Lynley Bradnam
- Discipline of Physiotherapy, School of Health Sciences, Flinders University, Australia; Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Australia.
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Acupuncture for 40 cases of spasmodic torticollis. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2017. [DOI: 10.1016/s1003-5257(17)30112-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mustalampi S, Ylinen J, Korniloff K, Weir A, Häkkinen A. Reduced Neck Muscle Strength and Altered Muscle Mechanical Properties in Cervical Dystonia Following Botulinum Neurotoxin Injections: A Prospective Study. J Mov Disord 2016; 9:44-9. [PMID: 26828215 PMCID: PMC4734985 DOI: 10.14802/jmd.15035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/23/2015] [Accepted: 11/10/2015] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate changes in the strength and mechanical properties of neck muscles and disability in patients with cervical dystonia (CD) during a 12-week period following botulinum neurotoxin (BoNT) injections. Methods Eight patients with CD volunteered for this prospective clinical cohort study. Patients had received BoNT injections regularly in neck muscles at three-month intervals for several years. Maximal isometric neck strength was measured by a dynamometer, and the mechanical properties of the splenius capitis were evaluated using two myotonometers. Clinical assessment was performed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) before and at 2, 4, 8, and 12 weeks after the BoNT injections. Results Mean maximal isometric neck strength at two weeks after the BoNT injections decreased by 28% in extension, 25% in rotation of the affected side and 17% in flexion. At four weeks, muscle stiffness of the affected side decreased by 17% and tension decreased by 6%. At eight weeks, the muscle elasticity on the affected side increased by 12%. At two weeks after the BoNT injections, the TWSTRS-severity and TWSTRS-total scores decreased by 4.3 and 6.4, respectively. The strength, muscle mechanical properties and TWSTRS scores returned to baseline values at 12 weeks. Conclusions Although maximal neck strength and muscle tone decreased after BoNT injections, the disability improved. The changes observed after BoNT injections were temporary and returned to pre-injection levels within twelve weeks. Despite having a possible negative effect on function and decreasing neck strength, the BoNT injections improved the patients reported disability.
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Affiliation(s)
- Sirpa Mustalampi
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
| | | | - Adam Weir
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Arja Häkkinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland ; Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Nevitt BN, Robinson N, Kratz G, Johnston MS. Effectiveness of Physical Therapy as an Adjunctive Treatment for Trauma-induced Chronic Torticollis in Raptors. J Avian Med Surg 2015; 29:30-9. [PMID: 25867664 DOI: 10.1647/2014-003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Management of trauma-induced chronic torticollis in raptors has historically been challenging. Euthanasia is common in affected birds because of their inability to maintain normal cervical position, although they may be able to function normally. To assess effectiveness of physical therapy of the neck and head as an adjunct treatment for this condition, a case-control study was done in raptors admitted to the Rocky Mountain Raptor Program from 2003 to 2010. Eleven cases were identified with a diagnosis of chronic torticollis resulting from traumatic brain injury. Five cases were treated with physical therapy of the head and neck, and 6 control cases did not receive any physical therapy for the torticollis. Of the control cases, 0 of 6 had resolution of the torticollis, 0 of 6 were released, and 5 of 6 were euthanatized. Of the treated cases, 4 of 5 had complete resolution of the torticollis and 5 of 5 were released. Resolution of torticollis differed significantly between cases receiving physical therapy and controls. These results indicate that physical therapy should be used as an adjunctive therapy in cases of chronic torticollis induced by trauma in raptors because it results in better resolution of the torticollis and increased likelihood of release.
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Bova JA, Sergent AW. Chiropractic care using a functional neurologic approach for idiopathic cervical dystonia in a 59-year-old woman. J Chiropr Med 2013; 12:60-5. [PMID: 24294147 DOI: 10.1016/j.jcm.2013.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 04/11/2013] [Accepted: 04/26/2013] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The purpose of this case report is to describe the care and outcomes of a patient with cervical dystonia who was treated using chiropractic and other alternative medicine interventions. CLINICAL FEATURES A 59-year-old woman had an 11-year history of cervical dystonia. She had an uncontrollable 60° leftward head rotation upon shutting her eyes and had spasmodic contractions that caused fatigue. INTERVENTION AND OUTCOME The management consisted of blue-lensed glasses, vibration stimulation, spinal manipulation, and eye-movement exercises. Within the first week of treatment, she had a reduction in symptoms, which was documented using a functional numeric scale, and improved posture, which was assessed using measurements from her midsternal line to the center of her chin. CONCLUSION This patient with cervical dystonia responded to the use of conservative, nonpharmacological treatment procedures that consisted of chiropractic care using a functional neurologic approach aimed at improving her spasmodic contractions and function.
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Voos MC, Oliveira TDP, Piemonte MEP, Barbosa ER. Case Report: Physical therapy management of axial dystonia. Physiother Theory Pract 2013; 30:56-61. [DOI: 10.3109/09593985.2013.799252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Liskova P, Ulmanova O, Tesina P, Melsova H, Diblik P, Hansikova H, Tesarova M, Votruba M. Novel OPA1 missense mutation in a family with optic atrophy and severe widespread neurological disorder. Acta Ophthalmol 2013; 91:e225-31. [PMID: 23387428 DOI: 10.1111/aos.12038] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To identify the underlying molecular genetic cause in a Czech family with optic atrophy, deafness, ptosis, ophthalmoplegia, polyneuropathy and ataxia transmitted as an autosomal dominant trait. METHODS Ophthalmological and neurological examination followed by molecular genetic analyses. RESULTS Seven family members were clinically affected. There was a variable but progressive visual, hearing and neurological disability across the family as a whole. The majority of subjects presented with impairment of visual function and a variable degree of ptosis and/or ophthalmoplegia from the first to the third decade of life. Deafness, neuropathy and ataxia appeared later, in the third and fourth decade. Migraine, tachycardia, intention tremor, nystagmus and cervical dystonia were observed in isolated individuals. A significant overall feature was the high level of neurological disability leading to 3 of 4 members being unable to walk or stand unaided before the age of 60 years. A novel missense mutation c.1345A>C (p.Thr449Pro) in OPA1 segregating with the disease phenotype over three generations was detected. In silico analysis supported pathogenicity of the identified sequence variant. CONCLUSION Our work expands the spectrum of mutation in OPA1, which may lead to severe multisystem neurological disorder. The molecular genetic cause of dominant optic atrophy in the Czech population is reported for the first time. We propose that regular cardiac follow-up in patients diagnosed with dominant optic atrophy and widespread neurological disease should be considered.
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Affiliation(s)
- Petra Liskova
- Laboratory of the Biology and Pathology of the Eye, Institute of Inherited Metabolic Disorders, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
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Fernandez HH, Pappert EJ, Comella CL, Evidente VGH, Truong DD, Verma A, Jankovic J. Efficacy and Safety of IncobotulinumtoxinA in Subjects Previously Treated with Botulinum Toxin Versus Toxin-Naïve Subjects with Cervical Dystonia. Tremor Other Hyperkinet Mov (N Y) 2013; 3:tre-03-140-2921-1. [PMID: 23610743 PMCID: PMC3629862 DOI: 10.7916/d87p8x43] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 10/31/2012] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND To determine whether botulinum toxin treatment history affected the outcomes of a study comparing the safety and efficacy of incobotulinumtoxinA with placebo in subjects with cervical dystonia (CD). METHODS This was a prospective, double-blind, randomized, placebo-controlled, multicenter trial in botulinum toxin-treated or toxin-naïve CD subjects. Subjects received a fixed dose of either 120 U or 240 U of incobotulinumtoxinA or placebo. The primary outcome measure was change from baseline to Week 4 in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) total score. Treatment-emergent adverse events (TEAEs) were also evaluated. This report represents a subgroup analysis of botulinum toxin-treated or toxin-naïve subjects. RESULTS Participants (N = 233; 38.6% toxin-naïve) had a mean age of 52.8 years. IncobotulinumtoxinA significantly improved TWSTRS total scores from baseline to Week 4 in both dose groups versus placebo, and the improvement persisted through the end of the study (≤20 weeks). Both the previously toxin-treated and toxin-naïve subjects demonstrated significant improvements in TWSTRS total scores at Week 4 compared to baseline. The most frequent TEAEs in the incobotulinumtoxinA groups were dysphagia, neck pain, and muscular weakness, which were generally mild. TEAEs were more common in the 240 U group and toxin-naïve subjects. DISCUSSION Overall, incobotulinumtoxinA was safe and effective in CD, regardless of toxin therapy history. A lower starting dose may be better tolerated among toxin-naïve subjects without sacrificing efficacy.
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Affiliation(s)
| | - Eric J. Pappert
- Merz Pharmaceuticals, LLC., Greensboro, North Carolina, United States of America
| | | | | | - Daniel D. Truong
- The Parkinson's & Movement Disorders Institute, Fountain Valley, California, United States of America
| | - Amit Verma
- Merz Pharmaceuticals, LLC., Greensboro, North Carolina, United States of America
| | - Joseph Jankovic
- Baylor College of Medicine, Houston, Texas, United States of America
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Abstract
Torticollis refers to a twisting of the head and neck caused by a shortened sternocleidomastoid muscle, tipping the head toward the shortened muscle, while rotating the chin in the opposite direction. Torticollis is seen at all ages, from newborns to adults. It can be congenital or postnatally acquired. In this review, we offer a new classification of torticollis, based on its dynamic qualities and pathogenesis. All torticollis can be classified as either nonparoxysmal (nondynamic) or paroxysmal (dynamic). Causes of nonparoxysmal torticollis include congenital muscular; osseous; central nervous system/peripheral nervous system; ocular; and nonmuscular, soft tissue. Causes of paroxysmal torticollis are benign paroxysmal; spasmodic (cervical dystonia); Sandifer syndrome; drugs; increased intracranial pressure; and conversion disorder. The description, epidemiology, clinical presentation, evaluation, treatment, and prognosis of the most clinically significant types of torticollis follow.
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Affiliation(s)
- Kinga K Tomczak
- Departments of Pediatrics and Neurology, Division of Pediatric Neurology, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA
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Hefter H, Benecke R, Erbguth F, Jost W, Reichel G, Wissel J. An open-label cohort study of the improvement of quality of life and pain in de novo cervical dystonia patients after injections with 500 U botulinum toxin A (Dysport). BMJ Open 2013; 3:bmjopen-2012-001853. [PMID: 23604344 PMCID: PMC3641454 DOI: 10.1136/bmjopen-2012-001853] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES It remains to be determined whether the benefits of botulinum toxin type A (BoNT-A) on cervical dystonia (CD) motor symptoms extend to improvements in patient's quality of life (QoL). This analysis of a large, multicentre study was conducted with the aim of investigating changes in QoL and functioning among de novo patients receiving 500 U BoNT-A (abobotulinumtoxinA; Dysport) for the treatment of the two most frequent forms of CD, predominantly torticollis and laterocollis. DESIGN A prospective, open-label study of Dysport (500 U; Ipsen Biopharm Ltd) administered according to a defined intramuscular injection algorithm. SETTING German and Austrian outpatient clinics. PARTICIPANTS 516 male and female patients (aged ≥18 years) with de novo CD. The majority of patients had torticollis (78.1%). 35 patients had concomitant depression (MedDRA-defined). MAIN OUTCOME MEASURES Change from baseline to weeks 4 and 12 in Craniocervical Dystonia Questionnaire (CDQ-24) total and subscale scores, patient diary items ('day-to-day capacities and activities', 'pain' and 'duration of pain') and global assessment of pain. RESULTS Significant improvements were observed in CDQ-24 total and subscale scores at week 4 and were sustained up to week 12 (p<0.001). Changes in CDQ-24 scores did not significantly differ between the torticollis and laterocollis groups or between patients with or without depression. There were also significant reductions in patient diary item scores for activities of daily living, pain and pain duration at weeks 4 and 12 (p<0.001). Pain relief (less or no pain) was reported by 66% and 74.1% of patients at weeks 4 and 12, respectively. Changes in pain parameters demonstrated a positive relationship with change in Tsui score. CONCLUSIONS After standardised open-label treatment with Dysport 500 U, improvements in QoL and pain intensity up to 12 weeks in patients with CD were observed.
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Affiliation(s)
- H Hefter
- Department of Neurology, University of Düsseldorf, Düsseldorf, Germany
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Abstract
Spasmodic torticollis or cervical dystonia (CD) is the most common form of focal dystonia and is characterized by sustained abnormal muscle contractions in the head and neck area resulting in abnormal positioning or posturing of the head. The dystonic muscle spasms associated with spasmodic torticollis may affect any combination of neck muscles. Three cases are reported of spasmodic torticollis that were treated by a dental appliance with individual varying occlusal heights to open the maxillomandibular vertical dimension. Upon increasing the vertical dimension of occlusion, there was a slowing and/or discontinuance of the symptoms of cervical dystonia. The proposed hypothesis for this reversal is that there may be neuritis of the auriculotemporal branch of the trigeminal nerve, which has direct input into the reticular formation (RF), and it may activate the cells of the pontine region of the RF known for the control and deviation of head posture. There is growing clinical evidence that temporomandibular joint (TMJ) dysfunction may be a factor in this neurological and painful disorder when it coexists.
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Vivancos-Matellano F, Ybot-Gorrin I, Diez-Tejedor E. A 17-year Experience of AbobotulinumtoxinA in Cervical Dystonia. Int J Neurosci 2012; 122:354-7. [DOI: 10.3109/00207454.2012.665971] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Kaufman R. Comanagement and collaborative care of a 20-year-old female with acute viral torticollis. J Manipulative Physiol Ther 2009; 32:160-5. [PMID: 19243729 DOI: 10.1016/j.jmpt.2008.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 06/15/2008] [Accepted: 07/02/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This case study describes a patient diagnosed with acute viral torticollis and illustrates the relevant aspects of differential diagnosis and the collaborative efforts between the chiropractic and allopathic disciplines in establishing an optimum treatment protocol provided by comanagement of the case. CLINICAL FEATURES A 20-year-old female student experienced a sudden onset of neck pain and inability to move her neck in conjunction with an antalgic attitude of her cervical spine in lateral flexion and rotation. Physical examination revealed an elevated temperature indicating the possibility of infection. Associated symptoms included headache, nausea, vomiting, and malaise. INTERVENTION AND OUTCOME The patient was initially assessed in a teaching clinic of a university medical health center for acute meningitis. A consultation was requested by the senior attending physician for an opinion by the chiropractic services of the university health center to assess the patient for nuchal rigidity and to provide treatment of the torticollis. After an evaluation of the status of the patient, a diagnosis of acute viral torticollis was established, and chiropractic manual therapy was initiated with a significant improvement in the ability of the patient to execute cervical ranges of motion without undue limitation and pain. Follow-up chiropractic care resulted in resolution of the torticollis without residual symptoms. CONCLUSION Acute viral torticollis occurring in a young adult with associated symptoms of fever, headache, nausea, and vomiting presents a diagnostic challenge in excluding the possibility of meningitis. Appropriate clinical and physical examination procedures are essential to exclude the latter while providing the clinician with the confidence to proceed with conservative management of the patient. Comanagement and collaborative care between the medical and chiropractic disciplines offered the patient a treatment plan with prompt resolution of symptoms.
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Affiliation(s)
- Rod Kaufman
- Clinic Division of Southern California, Department of Health Sciences, Southern California University of Health Sciences, Castaic, Calif, USA
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