title: Relevance of sonography for botulinum toxin treatment of cervical dystonia: an expert statement.
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.
authors.affiliation: Department of Neurology, University of Erlangen, Erlangen, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Schramm
authors.affiliation: Department of Movement Disorders and Neuropsychiatry, University of Lübeck, Lübeck, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Bäumer
authors.affiliation: Department of Neurology and Clinical Neurophysiology, Schön Klinik München Schwabing, Munich, Germany.
authors.forename: Urban
authors.initials: U
authors.lastname: Fietzek
authors.affiliation: Department of Neurology, Deutsche Klinik für Diagnostik, Wiesbaden, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Heitmann
authors.affiliation: Department of Neurology, University of Rostock, Rostock, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Walter
authors.affiliation: Department of Neurology, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany. wolfgang.jost@uniklinik-freiburg.de.
authors.forename: Wolfgang H
authors.initials: WH
authors.lastname: Jost
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005152:Facial Muscles / Q000000981:diagnostic imaging / Q000187:drug effects; D006801:Humans; D009334:Neck Muscles / Q000000981:diagnostic imaging / Q000187:drug effects; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D013813:Therapy, Computer-Assisted / Q000379:methods*; D014103:Torticollis / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D014463:Ultrasonography
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Botulinum toxin; Cervical dystonia; Sonography; Ultrasound