title: An ¹⁸F-FDG PET study of cervical muscle in parkinsonian anterocollis.
abstract: The underlying etiology of parkinsonian anterocollis has been the subject of recent debate. The purpose of this study is to test the hypothesis that anterocollis in parkinsonian syndromes is associated with dystonia of the deep cervical flexors (longus colli and capitis). Eight patients with anterocollis, six in the setting of parkinsonism and two primary cervical dystonia control subjects with anterocollis underwent prospective structured clinical evaluations (interview, examination and rating scales), systematic electromyography of the cervical extensor musculature and (18)F-FDG PET/CT studies of cervical muscles to examine evidence of hypermetabolism or overactivity of deep cervical flexors. Subjects with parkinsonian anterocollis were found to have hypermetabolism of the extensor and sub-occipital muscles but not in the cervical flexors (superficial or deep). EMG abnormalities were observed in all evaluated patients, but only one patient was definitely myopathic. Meanwhile, both dystonia controls exhibited hypermetabolism of cervical flexors (including the longus colli). In conclusion, we were able to demonstrate hypermetabolism of superficial and deep cervical flexors with muscle (18)F-FDG PET/CT in dystonic anterocollis patients, but not in parkinsonian anterocollis patients. The hypermetabolic changes seen in parkinsonian anterocollis patients in posterior muscles may be compensatory. Alternative explanations for anterocollis include myopathy of the cervical extensors, or unbalanced rigidity of the cervical flexors, but this remains to be proven.
authors.affiliation: Department of Neurosciences, Division of Neurology, Movement Disorder Program, Medical University of South Carolina, 326 Calhoun Street, Suite 308/MSC 108, Charleston, SC 29425, United States. Electronic address: revuelta@musc.edu.
authors.forename: Gonzalo J
authors.initials: GJ
authors.lastname: Revuelta
authors.affiliation: Lee Moffitt Cancer Center and Research Institute, University of South Florida Medical School, Tampa, FL, United States.
authors.forename: Jaime
authors.initials: J
authors.lastname: Montilla
authors.affiliation: Department of Neurology, Neuromuscular Division, University of Miami School of Medicine, Miami, FL, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Benatar
authors.affiliation: Department of Neurology, Movement Disorders Program, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Alan
authors.initials: A
authors.lastname: Freeman
authors.affiliation: Department of Neurology, Movement Disorders Program, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wichmann
authors.affiliation: Department of Neurology, Movement Disorders Program, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Hyder A
authors.initials: HA
authors.lastname: Jinnah
authors.affiliation: Department of Neurology, Movement Disorders Program, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Mahlon R
authors.initials: MR
authors.lastname: Delong
authors.affiliation: Department of Neurology, Movement Disorders Program, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Stewart A
authors.initials: SA
authors.lastname: Factor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004421:Dystonia / Q000151:congenital; D004576:Electromyography; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D009334:Neck Muscles / Q000000981:diagnostic imaging*; D020734:Parkinsonian Disorders / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D049268:Positron-Emission Tomography; D015898:Tomography Scanners, X-Ray Computed; D014103:Torticollis / Q000150:complications / Q000151:congenital* / Q000000981:diagnostic imaging / Q000473:pathology
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: Anterocollis; Dystonia; EMG; FDG-PET; Parkinson's disease
references.citation: Mov Disord. 2006 Aug;21(8):1213-6
references.pmid: 16703588
references.citation: Parkinsonism Relat Disord. 2012 Jan;18(1):30-4
references.pmid: 21873101
references.citation: Semin Nucl Med. 1996 Oct;26(4):308-14
references.pmid: 8916319
references.citation: J Neurol Sci. 2012 Apr 15;315(1-2):100-3
references.pmid: 22133481
references.citation: Arch Neurol. 2001 Feb;58(2):232-7
references.pmid: 11176961
references.citation: Ann Rehabil Med. 2012 Dec;36(6):745-55
references.pmid: 23342305
references.citation: Mov Disord. 2010 Apr 15;25(5):552-9
references.pmid: 20014064
references.citation: Lancet Neurol. 2011 Jun;10(6):538-49
references.pmid: 21514890
references.citation: Parkinsonism Relat Disord. 2009 Nov;15(9):633-9
references.pmid: 19574084
references.citation: Mov Disord. 2001 Jul;16(4):754-6
references.pmid: 11481704
references.citation: Nat Rev Neurol. 2010 Jan;6(1):29-37
references.pmid: 20057497
references.citation: Parkinsonism Relat Disord. 2009 Mar;15(3):181-6
references.pmid: 18573677
references.citation: Neurology. 2008 Aug 26;71(9):670-6
references.pmid: 18725592
references.citation: AJR Am J Roentgenol. 2009 Apr;192(4):996-1001
references.pmid: 19304706
references.citation: J Neurol Sci. 1999 Aug 1;167(1):22-5
references.pmid: 10500257
references.citation: Mov Disord. 2010 Apr 15;25(5):542-51
references.pmid: 20108372
references.citation: J Appl Physiol (1985). 2001 Jan;90(1):329-37
references.pmid: 11133926
references.citation: Mov Disord. 2006 Nov;21(11):1856-63
references.pmid: 16941460
references.citation: Mov Disord. 2007 Dec;22(16):2325-31
references.pmid: 17960814
references.citation: Mov Disord. 2011 Jul;26(8):1569-71
references.pmid: 21520279
references.citation: Curr Neurol Neurosci Rep. 2012 Aug;12(4):386-91
references.pmid: 22639084
references.citation: Mov Disord. 2010 Apr 15;25(5):527-8
references.pmid: 20425791
references.citation: Mol Imaging Biol. 2009 Sep-Oct;11(5):364-8
references.pmid: 19326174
references.citation: Mov Disord. 2001 Nov;16(6):1086-90
references.pmid: 11748739
references.citation: J Nucl Med. 2007 Nov;48(11):1790-5
references.pmid: 17942812