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2 results

  • Chapter 5 - Examination and Treatment of Complex Cervical Dystonia

  • Edited by Daniel Truong, University of California, Riverside, Dirk Dressler, Hannover Medical School, Mark Hallett, National Institutes of Health (NIH), Christopher Zachary, University of California, Irvine, Mayank Pathak, Truong Neuroscience Institute
  • Book:
    Manual of Botulinum Toxin Therapy
    Published online:
    02 November 2023
    Print publication:
    23 November 2023, pp 23-33

  • Summary

    In cervical dystonia (CD), outcome of treatment with botulinum neurotoxin (BoNt), is highly dependent on the correct identificationof the muscles involved. There are “simple” (in one plane) and “complex” (in two or more levels) forms of CD. The difficulty lies in the treatment of complex CD, requiring a more extensive analysis. For such analysis, different diagnostic methods are used. These include: ultrasound, CT neck soft tissue imaging (particularly the deep muscles of the neck), electromyography (EMG) of neck muscles, and standardized photographs of patients with measurements of angles (head, neck, thorax).

    Cervical dystonia may occur in principle in three axes (rotation, lateral flexion and sagittal flexion). The head or the neck can be affected alone in each of these planes of movements. Therefore, eight clinical forms can be distinguished: torticollis, laterocollis, antecollis, retrocollis, torticaput, laterocaput, antecaput and retrocaput. In this chapter, involved muscles, their origins and insertions are presented in a table for each of these clinical forms. Injection under CT guidance is described.

  • Biased Visuospatial Attention in Cervical Dystonia

  • Gaetana Chillemi, Caterina Formica, Adriana Salatino, Alessandro Calamuneri, Paolo Girlanda, Francesca Morgante, Demetrio Milardi, Carmen Terranova, Alberto Cacciola, Angelo Quartarone, Raffaella Ricci
  • Journal:
    Journal of the International Neuropsychological Society / Volume 24 / Issue 1 / January 2018
    Published online by Cambridge University Press:
    09 August 2017, pp. 22-32

  • Objectives: There is increasing evidence of non-motor, sensory symptoms, mainly involving the spatial domain, in cervical dystonia (CD). These manifestations are likely driven by dysfunctional overactivity of the parietal cortex during the execution of a sensory task. Few studies also suggest the possibility that visuospatial attention might be specifically affected in patients with CD. Therefore, we asked whether non-motor manifestations in CD might also comprise impairment of higher level visuospatial processing. Methods: To this end, we investigated visuospatial attention in 23 CD patients and 12 matched healthy controls (for age, gender, education, and ocular dominance). The patients were identified according to the dystonia pattern type (laterocollis vs. torticollis). Overall, participants were right-handers, and the majority of them was right-eye dominant. Visuospatial attention was assessed using a line bisection task. Participants were asked to bisect horizontal lines, using their right or left hand. Results: Participants bisected more to the left of true center when using their left hand to perform the task than when using their right hand. However, overall, torticollis patients produced a significantly greater leftward deviation than controls. Conclusions: These data are consistent with preliminary findings suggesting the presence of biased spatial attention in patients with idiopathic cervical dystonia. The presence of an attentional bias in patients with torticollis seem to indicate that alterations of attentional circuits might be implicated in the pathophysiology of this type of CD. (JINS, 2018, 24, 23–32)