Parkinson-Klinik Ortenau, Kreuzbergstr. 12, 77709, Wolfach, Germany.
Department of Neuromuscular Diseases, CHRU Besançon, University of Franche-Comté, Besançon, France.
J Neural Transm (Vienna). 2020 Jan;127(1):45-50. doi: 10.1007/s00702-019-02116-7. Epub 2019 Dec 11.
Patients with cervical dystonia (CD) may present with head and/or neck movements in the coronal, sagittal or transverse plane. According to the Col-Cap concept, CD postures are classified in torti-, latero-, ante- and retrocollis/caput patterns. The frequency of these different subtypes has to be evaluated. Between January and June 2019, we examined 306 patients (55.5 ± 13.1 years, 67% female) with CD according to the Col-Cap concept. They were all treated with botulinum toxin. This prospective study took place in seven different movement disorder centers. The most common primary form was torticaput (49%), the second most common was laterocaput (16.7%). All other subtypes were less than 10% of the study population. Pure forms were observed in 16.3% of patients only. Torticaput was combined in 46% with laterocaput, and in 20.7% with retrocaput. Laterocaput was combined mainly with torticaput (45.1%), laterocollis (33.2%) or retrocaput (23.5%). Shift forms were found in 14.7%, but diagnosed only in 3.9%. On average, the patients had 2.51 (± SD 1.09) subtypes each. Tremor was observed in 55.6%. The mean number of injected muscles was 4.4 (SD 1.6). The most often injected muscles were splenius capitis (83%), sternocleidomatoideus (79.1%), and upper trapezius (58.5%). This is the first multicenter study to examine the frequency of different subtypes of CD according to the Col-Cap concept. The caput subforms are more common than the cervical types, with torticaput as the most common one. Shift forms were diagnosed less often than described. Pure forms are very rare, combinations of 2-6 subtypes are common (83.7%). Sternocleidomatoideus, splenius capitis and trapezius muscles were still injected most often, but the muscles rarely injected in the past such as levator scapulae (48.7%), obliquus capitis inferior (35.3%) and longissimus (16.7%) were considered quite often. Since optimal therapy results depend on the injection of the right muscles, the correct classification should optimize the treatment outcome.
患者患有颈部肌张力障碍 (CD) 可能会出现冠状位、矢状位或横位的头部和/或颈部运动。根据 Col-Cap 概念，CD 姿势分为扭曲、侧向、前向和后向斜颈/头模式。必须评估这些不同亚型的频率。2019 年 1 月至 6 月，我们根据 Col-Cap 概念检查了 306 名患有 CD 的患者（55.5 ± 13.1 岁，67%为女性）。他们都接受了肉毒毒素治疗。这项前瞻性研究在七个不同的运动障碍中心进行。最常见的原发性形式是扭曲斜颈（49%），第二常见的是侧向斜颈（16.7%）。研究人群中所有其他亚型均小于 10%。只有 16.3%的患者为单纯形式。扭曲斜颈与侧向斜颈结合占 46%，与后斜颈结合占 20.7%。侧向斜颈主要与扭曲斜颈（45.1%）、侧向斜颈（33.2%）或后斜颈（23.5%）结合。移位形式占 14.7%，但仅诊断出 3.9%。平均而言，每位患者的亚型为 2.51（±标准差 1.09）。震颤发生率为 55.6%。注射的肌肉平均数量为 4.4（SD 1.6）。最常注射的肌肉是头夹肌（83%）、胸锁乳突肌（79.1%）和上斜方肌（58.5%）。这是第一项根据 Col-Cap 概念检查 CD 不同亚型频率的多中心研究。头部亚型比颈部类型更常见，其中扭曲斜颈最常见。移位形式的诊断比描述的要少。单纯形式非常罕见，2-6 种亚型的组合很常见（83.7%）。胸锁乳突肌、头夹肌和斜方肌仍然是最常注射的肌肉，但过去很少注射的肌肉，如肩胛提肌（48.7%）、头下斜肌（35.3%）和最长肌（16.7%）也经常被考虑。由于最佳治疗效果取决于正确肌肉的注射，因此正确的分类应该优化治疗效果。
