Abstract
Botulinum neurotoxin A (BoNT A) is the first-line treatment for cervical dystonia. However, although BoNT A has a favorable safety profile and is effective in the majority of patients, in some cases the treatment outcome is disappointing or side effects occur when higher doses are used. It is likely that in such cases either the target muscles were not injected accurately or unintended weakness of non-target muscles occurred. It has been demonstrated in clinical trials for spastic movement disorders that sonography-guided BoNT A injections could improve treatment outcome. As the published evidence for a benefit of sonography-guided BoNT injection in patients with cervical dystonia is scarce, it is the aim of this review to discuss the relevance of sonography in this indication and provide a statement from clinical experts for its use. The clear advantage of sonography-guided injections is non-invasive, real-time visualization of the targeted muscle, thus improving the precision of injections and potentially the treatment outcomes as well as avoiding adverse effects. Other imaging techniques are of limited value due to high costs, radiation exposure or non-availability in clinical routine. In the hands of a trained injector, sonography is a quick and non-invasive imaging technique. Novel treatment concepts of cervical dystonia considering the differential contributions of distinct cranial and cervical muscles can reliably be implemented only by use of imaging-guided injection protocols.
| Original language | English |
|---|---|
| Journal | Journal of Neural Transmission |
| Volume | 122 |
| Issue number | 10 |
| Pages (from-to) | 1457-1463 |
| Number of pages | 7 |
| ISSN | 0300-9564 |
| DOIs | |
| Publication status | Published - 01.10.2015 |
Funding
Axel Schramm, MD, received research grants from Pharm Allergan and Ipsen Pharma. He is also a consultant for Ipsen Pharma and received compensation for lectures and training courses from Pharm Allergan, Ipsen Pharma, Merz Pharmaceuticals, and Novartis. Tobias Bäumer, MD, received honoraria from Pharm Allergan and Ipsen Pharma for advanced training courses and lectures and from Merz Pharmaceuticals as a consultant, for advanced training courses and lectures. Urban Fietzek, MD, reports personal fees from Pharm Allergan, Merz Pharmaceuticals, Ipsen Pharma, Meda Pharma, and Desitin outside the submitted work. Susanne Heitmann, MD, received speaker honoraria from Merz Pharmaceuticals, Ipsen Pharma, and Pharm Allergan. Uwe Walter, MD, received speaker honoraria from Merz Pharmaceuticals and Ipsen Pharma and travel grants from Pharm Allergan. Wolfgang H. Jost, MD, received speaker honoraria and is a consultant for Pharm Allergan, Ipsen Pharma, and Merz Pharmaceuticals. The authors report no conflict of interest in regards to the content of this article. Professional writing assistance in the preparation of this manuscript was provided by Bärbel Schmidt, Ph.D., and was funded by Ipsen Pharma GmbH.
