Neurology, London BTX Centre, London, United Kingdom.
ENT Department, St George's Hospital NHS Foundation Trust, London, United Kingdom.
Parkinsonism Relat Disord. 2021 Jul;88:34-39. doi: 10.1016/j.parkreldis.2021.05.024. Epub 2021 May 29.
Anterocollis (AC) is a rare form of cervical dystonia, which responds poorly to botulinum toxin treatment.
To recognise the different clinical phenotypes of AC and to detail the selection of muscles from the results of treating a cohort of 15 AC patients with Botulinum Toxin.
The study was performed using prospectively collected data. We included 15 patients with cervical dystonia and AC posture, treated between 2016 and 2019 in our joint Neuro-ENT clinic. We excluded patients with posterior cervical muscle weakness and patients with Parkinsonism. We characterised the primary dystonic posture of every AC patient as posterior sagittal shift, head flexion or neck flexion, or a combination of the three.
All AC patients had a more widespread dystonic picture with a majority having Meige syndrome, but AC was the most problematic feature. Treatment with botulinum toxin required the injection not only of the deep cervical flexor (DCF), but also the sterno-cleido-mastoid (SCM) and moreover the supra-hyoid (SH) muscles. The choice between the longus capiti and the longus colli depended on the AC posture. Half of the patients had a dramatic improvement with 90% satisfaction or above.
AC posture is a complex but treatable type of CD. A joint Neuro-ENT clinic is an ideal setting in which to target all the dystonic muscles. This allows the injection of the longus capiti (under nasal endoscopic approach) as well as the supra-hyoid and SCM muscles in the same session.
前屈颈（AC）是一种罕见的颈部肌张力障碍形式，对肉毒毒素治疗反应不佳。
认识 AC 的不同临床表型，并详细说明从治疗 15 例 AC 患者的肉毒毒素治疗结果中选择肌肉。
本研究采用前瞻性收集的数据进行。我们纳入了 2016 年至 2019 年间在我们的神经耳科联合诊所治疗的 15 例患有颈部肌张力障碍和 AC 姿势的患者。我们排除了有颈部后肌无力和帕金森病的患者。我们将每个 AC 患者的原发性张力障碍姿势特征化为后矢状移位、头部前屈或颈部前屈，或三者的组合。
所有 AC 患者都有更广泛的张力障碍表现，大多数患者有 Meige 综合征，但 AC 是最成问题的特征。肉毒毒素治疗需要不仅注射深部颈屈肌（DCF），还需要注射胸锁乳突肌（SCM），而且还需要注射舌骨上肌（SH）。长头肌和长颈肌的选择取决于 AC 的姿势。一半的患者有明显的改善，90%以上的患者满意度在 90%以上。
AC 姿势是一种复杂但可治疗的 CD 类型。神经耳科联合诊所是靶向所有张力障碍肌肉的理想场所。这允许在同一治疗中注射长头肌（经鼻内窥镜入路）以及舌骨上肌和 SCM 肌肉。
