title: Collum-caput (COL-CAP) concept for conceptual anterocollis, anterocaput, and forward sagittal shift.
abstract: OBJECTIVE
  Anterocollis as a rare subtype of cervical dystonia is difficult to treat and thus less appreciated than other subtypes of cervical dystonia. This review aimed at summarising and discussing recent advances in the management of anterocollis.
  
  
  METHODS
  Literature review.
  
  
  RESULTS
  Pure anterocollis is a rare condition but 1-24% of the cases of complex cervical dystonia present with an anterocollis component. Applying the collum-caput concept, anterocollis may be subdivided into conceptual anterocollis, anterocaput, and forward sagittal shift, which is useful to direct selection of dystonic muscles for treatment. Additionally, identification of dystonic muscles in conceptual anterocollis, anterocaput, or forward sagittal shift is achieved by electromyography, computed tomography, magnetic resonance imaging, or FDG-positron emission tomography. Treatment of choice is botulinum toxin A. In case of treatment failure, more rarely affected muscles need to be identified and injected. Deep muscles, as are frequently involved in conceptual anterocollis, anterocaput, and forward sagittal shift, should be injected only under guidance of electromyography, endoscopy, or imaging. The more accurately affected muscles are identified, the better the outcome.
  
  
  CONCLUSIONS
  Anterocollis as a subtype of cervical dystonia, responds poorly to botulinum toxin but management of this condition can be improved by application of identifying and guiding technologies.
authors.affiliation: Krankenanstalt Rudolfstiftung, Vienna, Austria. Electronic address: fifigs1@yahoo.de.
authors.forename: Josef
authors.initials: J
authors.lastname: Finsterer
authors.affiliation: Division of Neurology, General Hospital, Murcia, Spain.
authors.forename: Concha
authors.initials: C
authors.lastname: Maeztu
authors.affiliation: Department of Neurosciences, Division of Neurology, Movement Disorder Program, Medical University of South Carolina, Charleston, USA.
authors.forename: Gonzalo J
authors.initials: GJ
authors.lastname: Revuelta
authors.affiliation: Kompetenzzentrum für Bewegungsstörungen Paracelsusklinik Zwickau, Zwickau, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Reichel
authors.affiliation: The Parkinson and Movement Disorder Institute, 9940 Talbert Ave, Fountain Valley, CA 92708, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Truong
mesh_terms: D001905:Botulinum Toxins / Q000627:therapeutic use; D046690:Deep Brain Stimulation; D019416:Head Movements / Q000502:physiology*; D006801:Humans; D009334:Neck Muscles / Q000503:physiopathology*; D009498:Neurotoxins / Q000627:therapeutic use; D004856:Postural Balance / Q000502:physiology*; D014103:Torticollis / Q000145:classification / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D009498:Neurotoxins; D001905:Botulinum Toxins
keywords: Botulinum toxin; Focal dystonia; Movement disorder; Neurotoxin; Pain relief