Selective Cervical Denervation for Cervical Dystonia: Modification of the Bertrand Procedure

2017 ◽  
Vol 14 (5) ◽  
pp. 546-555 ◽  
Author(s):  
Thomas J Wilson ◽  
Robert J Spinner
Keyword(s):  
Cervical Dystonia ◽  
Neurological Disorder ◽  
Spasmodic Torticollis ◽  
Surgical Strategy ◽  
Advantages And Disadvantages ◽  
Levator Scapulae ◽  
Involuntary Contraction ◽  
Splenius Capitis ◽  
Surgical Option

Abstract BACKGROUND Cervical dystonia, commonly referred to as spasmodic torticollis, is a neurological disorder characterized by aberrant, involuntary contraction of the muscles of the neck and shoulders. One surgical option that can be considered is selective cervical denervation. OBJECTIVE To report our modification of the Bertrand procedure for selective cervical denervation. METHODS Our modification of the Bertrand procedure for selective cervical denervation is reported with intraoperative photographs and schematic depictions of the operative steps. RESULTS We report our modification of the Bertrand procedure for selective cervical denervation, which consists of a combination of C2-6 denervation, myectomy of the splenius capitis and/or semispinalis capitis, myotomy of the levator scapulae when indicated, and myotomy and selection denervation of the sternocleidomastoid. The combination of techniques utilized depends on the subtype and severity of cervical dystonia. CONCLUSION Our modification of the original Bertrand procedure for selective cervical denervation represents an alternative surgical strategy for the treatment of cervical dystonia, with the potential advantages and disadvantages discussed.

scholarly journals The physical, social and emotional aspects are the most affected in the quality of life of the patients with cervical dystonia

2014 ◽  
Vol 72 (6) ◽  
pp. 405-410 ◽  
Author(s):  
Roberta Weber Werle ◽  
Sibele Yoko Mattozo Takeda ◽  
Marise Bueno Zonta ◽  
Ana Tereza Bittencourt Guimarães ◽  
Hélio Afonso Ghizoni Teive
Keyword(s):  
Quality Of Life ◽  
Cervical Dystonia ◽  
Rating Scale ◽  
Motor Impairment ◽  
Residual Effect ◽  
Spasmodic Torticollis ◽  
Social And Emotional ◽  
Emotional Aspects ◽  
Craniocervical Dystonia

Objective : Describe the functional, clinical and quality of life (QoL) profiles in patients with cervical dystonia (CD) with residual effect or without effect of botulinum toxin (BTX), as well as verify the existence of correlation between the level of motor impairment, pain and QoL. Method : Seventy patients were assessed through the Craniocervical dystonia questionnaire-24 (CDQ-24) and the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Results : The greater the disability, pain and severity of dystonia, the worse the QoL (p<0.0001). Greater severity relates to greater disability (p<0.0001). Pain was present in 84% of the sample, being source of disability in 41%. The most frequent complaints were: difficulty in keeping up with professional and personal demands (74.3%), feeling uneasy in public (72.9%), hindered by pain (68.6%), depressed, annoyed or bitter (47.1%), lonely or isolated (32.9%). Conclusion : The physical, social and emotional aspects are the most affected in the QoL of these patients.

Cervicobrachial pain syndrome, cervical dystonia, and spasmodic torticollis

2013 ◽  
pp. 55-58
Author(s):  
Eric S. Hsu ◽  
Charles Argoff ◽  
Katherine E. Galluzzi ◽  
Raphael J. Leo ◽  
Andrew Dubin
Keyword(s):  
Cervical Dystonia ◽  
Pain Syndrome ◽  
Spasmodic Torticollis

Bilateral Deep Brain Stimulation for Cervical Dystonia: Long-term Outcome in a Series of 10 Patients

Neurosurgery ◽  
2010 ◽  
Vol 67 (4) ◽  
pp. 957-963 ◽  
Author(s):  
Francesco Cacciola ◽  
Jibril Osman Farah ◽  
Paul R Eldridge ◽  
Patricia Byrne ◽  
Telekath K Varma
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Cervical Dystonia ◽  
Rating Scale ◽  
Spasmodic Torticollis ◽  
Long Term Outcome ◽  
Stimulation Parameters ◽  
Deep Brain

Abstract BACKGROUND: Bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) was shown to be effective in cervical dystonia refractory to medical treatment in several small short-term and 1 long-term follow-up series. Optimal stimulation parameters and their repercussions on the cost/benefit ratio still need to be established. OBJECTIVE: To report our long-term outcome with bilateral GPi deep brain stimulation in cervical dystonia. METHODS: The Toronto Western Spasmodic Torticollis Rating Scale was evaluated in 10 consecutive patients preoperatively and at last follow-up. The relationship of improvement in postural severity and pain was analyzed and stimulation parameters noted and compared with those in a similar series in the literature. RESULTS: The mean (standard deviation) follow-up was 37.6 (16.9) months. Improvement in the total Toronto Western Spasmodic Torticollis Rating Scale score as evaluated at latest follow-up was 68.1% (95% confidence interval: 51.5-84.6). In 4 patients, there was dissociation between posture severity and pain improvement. Prevalently bipolar stimulation settings and high pulse widths and amplitudes led to excellent results at the expense of battery life. CONCLUSION: Improvement in all 3 subscale scores of the Toronto Western Spasmodic Torticollis Rating Scale with bilateral GPi deep brain stimulation seems to be the rule. Refinement of stimulation parameters might have a significant impact on the cost/benefit ratio of the treatment. The dissociation of improvement in posture severity and pain provides tangible evidence of the complex nature of cervical dystonia and offers interesting insight into the complex functional organization of the GPi.

scholarly journals The Canadian multicenter trial of pallidal deep brain stimulation for cervical dystonia: preliminary results in three patients

2004 ◽  
Vol 17 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Zelma H. T. Kiss ◽  
Kristina Doig ◽  
Michael Eliasziw ◽  
Ranjiit Ranawaya ◽  
Oksana Suchowersky
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Cervical Dystonia ◽  
Rating Scale ◽  
Short Form ◽  
Spasmodic Torticollis ◽  
Secondary Outcome ◽  
Preliminary Results ◽  
Abnormal Movements ◽  
Deep Brain

Object Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is beneficial for generalized dystonia and has been proposed as a treatment for cervical dystonia. The Canadian Stereotactic/Functional and Movement Disorders Groups designed a pilot project to investigate the following hypothesis: that bilateral DBS of the GPi will reduce the severity of cervical dystonia at 1 year of follow up, as scored in a blinded fashion by two neurologists using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Secondary outcome measures included pain and disability subscores of the TWSTRS, Short Form–36 quality of life index, and the Beck Depression Inventory. Methods Three patients have undergone surgery in Calgary with a followup duration of 7.4 ± 5.9 months (mean ± standard deviation). One patient underwent inadvertent ineffective stimulation for the first 3 months and did not experience a benefit until DBS programming was corrected. All three patients had rapid response to stimulation, with the muscles relaxing immediately and abnormal movements improving within days. Total TWSTRS scores improved by 79%, and severity subscores improved significantly, from 15.7 ± 2.1 to 7.7 ± 2.9 (paired ttest, p = 0.02). Pain and disability subscores improved from 25.5 ± 4.1 to 3.3 ± 3.1 (paired ttest, p = 0.002) and from 13.3 ± 4.9 to 3.3 ± 4.2 (paired ttest, p = 0.06), respectively. Conclusions Although it is too early to reach broad conclusions, this report of preliminary results confirms the efficacy of DBS of the GPi for cervical dystonia.

scholarly journals Relationship Between Sleep, Neck Muscle Activity, and Pain in Cervical Dystonia

1996 ◽  
Vol 23 (4) ◽  
pp. 285-290 ◽  
Author(s):  
Frank Lobbezoo ◽  
Marc Thu Thon ◽  
Guy Rémillard ◽  
Jacques Y. Montplaisir ◽  
Gilles J. Lavigne
Keyword(s):  
Muscle Activity ◽  
Cervical Dystonia ◽  
Nrem Sleep ◽  
Spinal Pain ◽  
Spasmodic Torticollis ◽  
Controlled Study ◽  
Emg Activity ◽  
Neck Muscle ◽  
Upper Trapezius ◽  
Before And After

AbstractObjective: The interactions between sleep, neck muscle activity, and cervical spinal pain were examined in a controlled study with nine patients suffering from idiopathic cervical dystonia (ICD; also referred to as spasmodic torticollis), and nine gender- and age-matched controls. Methods: From each participant, two all-night polysomnograms with additional electromyographic recordings from the sternocleidomastoid and upper trapezius muscles were obtained. The first night was for habituation to the laboratory environment; the second night for experimental data collection. Visual analogue scales were used to collect intensity and unpleasantness ratings of cervical spinal pain before and after the second sleep recording. Results: None of the standard sleep variables showed statistically significant differences between average values of both groups of participants. However, a significantly larger variance in sleep latency was obtained for the ICD patients. In general, abnormal cervical muscle activity decreased immediately when lying down without the intention to go to sleep. Subsequently, abnormal muscle contractions were gradually abolished in all ICD patients during the transition from relaxed wakefulness to light NREM sleep. Following this transition phase, no more abnormal EMG activity was found in any of our patients. Finally, cervical spinal pain intensity and unpleasantness were reduced by about 50% overnight. Conclusions: Both supine position and sleep can be associated with an improvement of symptoms of ICD, and this disorder does not induce any sleep perturbations.

Supracondylar fractures of the femur

2011 ◽  
Author(s):  
Wingrove T. Jarvis ◽  
Ananda M. Nanu
Keyword(s):  
High Energy ◽  
Fracture Pattern ◽  
Low Energy ◽  
Supracondylar Fractures ◽  
Advantages And Disadvantages ◽  
The Individual ◽  
Fractures Of The Femur ◽  
Surgical Option

♦ Supracondylar fractures of the femur are seen in the young (high energy) and the old (low energy). Both groups have their own specific problems♦ The advantages and disadvantages of each surgical option must be considered in relation to the individual patient and their fracture pattern.

scholarly journals Cervical lympahadenitis with risperidone induced cervical dystonia

2019 ◽  
Vol 5 (9) ◽  
pp. 257
Author(s):  
Ruchitha Reddy Akkati
Keyword(s):  
Cervical Dystonia ◽  
Antipsychotic Drugs ◽  
Clinical Manifestations ◽  
Cervical Lymphadenopathy ◽  
Spasmodic Torticollis ◽  
Spinal Curvature ◽  
Adult Onset ◽  
Body Regions ◽  
Inflammatory Processes ◽  
Head Neck

<p class="abstract">Abiogenic cervical dystonia, the most ordinary form of adult-onset focal dystonia, is elucidated as reflex muscle contractions. Idiopathic cervical dystonia is also called as spasmodic torticollis. The most habitually obliging medications were tetrabenazine (68% of patients upgraded) and anticholinergics (39% upgraded). Clinical manifestations include spinal curvature, local pain, muscle spasm, head-neck tremor and tremor in additional body regions. Antipsychotic drugs induce persistent dystonia. Lymphadenitis particularly refers to lymphadenopathies that are kindled by inflammatory processes. Treatment for lymphadenitis is complete antibiotic course of 10-14 days. A female patient of 14 years old<strong> </strong>presented with altered sensorium and neck tightness. She was diagnosed with cervical lymphadenopathy with risperidone induced cervical dystonia. She was treated with antibiotics and the patient was relieved from her symptoms by stopping the intake of risperidone for about 2 days.</p>

scholarly journals Accuracy of Ultrasound-Guided and Non-guided Botulinum Toxin Injection Into Neck Muscles Involved in Cervical Dystonia: A Cadaveric Study

2020 ◽  
Vol 44 (5) ◽  
pp. 370-377
Author(s):  
Yun Dam Ko ◽  
Soo In Yun ◽  
Dahye Ryoo ◽  
Myung Eun Chung ◽  
Jihye Park
Keyword(s):  
Botulinum Toxin ◽  
Neck Muscles ◽  
Injection Technique ◽  
Ultrasound Guided ◽  
Upper Trapezius ◽  
Levator Scapulae ◽  
Group A ◽  
Splenius Capitis ◽  
Group B ◽  
Botulinum Toxin Injections

Objective To compare the accuracy of ultrasound-guided and non-guided botulinum toxin injections into the neck muscles involved in cervical dystonia.Methods Two physicians examined six muscles (sternocleidomastoid, upper trapezius, levator scapulae, splenius capitis, scalenus anterior, and scalenus medius) from six fresh cadavers. Each physician injected ultrasound-guided and non-guided injections to each side of the cadaver’s neck muscles, respectively. Each physician then dissected the other physician’s injected muscle to identify the injection results. For each injection technique, different colored dyes were used. Dissection was performed to identify the results of the injections. The muscles were divided into two groups based on the difficulty of access: sternocleidomastoid and upper trapezius muscles (group A) and the levator scapulae, splenius capitis, scalenus anterior, and scalenus medius muscles (group B).Results The ultrasound-guided and non-guided injection accuracies of the group B muscles were 95.8% and 54.2%, respectively (p<0.001), while the ultrasound-guided and non-guided injection accuracies of the group A muscles were 100% and 79.2%, respectively (p<0.05).Conclusion Ultrasound-guided botulinum toxin injections into inaccessible neck muscles provide a higher degree of accuracy than non-guided injections. It may also be desirable to consider performing ultrasound-guided injections into accessible neck muscles.

P65 Implementing a pain scale to improve botulinum toxin practice for cervical dystonia

2019 ◽  
Vol 90 (3) ◽  
pp. e39.4-e40
Author(s):  
Aaron Jesuthasan ◽  
Amit Batla ◽  
Kailash Bhatia
Keyword(s):  
Patient Satisfaction ◽  
Cervical Dystonia ◽  
Pain Scale ◽  
Spasmodic Torticollis ◽  
Clinical Team ◽  
Standard Assessment ◽  
Pain Scales ◽  
Pain Subscale ◽  
Satisfaction Rates ◽  
To Receive

ObjectivesTo evaluate the effectiveness of introducing a pain scale to improve cervical dystonia (CD) patient satisfaction rates in the National Hospital for Neurology and Neurosurgery (NHNN) Botox clinic.DesignCase control study.SubjectsSubjects included CD patients attending the NHNN Botox clinic to receive injections.MethodsInjectors were educated about the Toronto Western Spasmodic Torticollis Rating pain subscale (TWSTRS) and subsequently incorporated it into their standard assessment of CD patients prior to injections. Surveys were created and disseminated to patients immediately following their appointment to assess their opinions of the clinical team. Information was entered into Microsoft Excel and analysed using appropriate statistical methods. Results were compared with a previous NHNN Botox clinic audit.Results42 surveys were collected in total from CD patients over a 4 week period. 36 patients (85.7%) reported pain associated with the condition. In comparison to an audit conducted in 2016, involving a similar sample size (n=40, with 28 reporting pain), a higher proportion of CD patients felt their pain was well understood by the clinical team (89.3% vs 94.4%). Furthermore, a higher proportion felt the team were competent in managing their pain (67.9% vs 94.4%).ConclusionsOur study supports the use of a TWSTRS pain subscale to improve CD patient satisfaction rates in the Botox clinic. Further studies are encouraged to validate these findings and determine other suitable pain scales for implementation.

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