Movement disorders department, CHU Lille, 59000 Lille, France.
Movement disorders department, CHU Lille, 59000 Lille, France; University Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, 59000 Lille, France.
Rev Neurol (Paris). 2022 Jun;178(6):591-602. doi: 10.1016/j.neurol.2021.11.005. Epub 2021 Dec 13.
Ultrasound-guided injections of botulinum neurotoxin in cervical dystonia have a number of theoretical advantages. However, their action has never been compared to that of non-guided injections. The objectives of the study were to compare the outcome of botulinum neurotoxin type A treatment in patients with idiopathic, focal cervical dystonia, according to two methods: inspection and palpation of anatomical landmarks (non-guided group) or ultrasound guidance (ultrasound-guided group).
We included consecutive patients in this single-center, prospective, real-life, non-randomized study. The outcomes were evaluated one month after the injections: Cervical Dystonia Impact Profile 58 (main outcome), Toronto Western Spasmodic Torticollis Rating Scale-2 (pain and disability subscores), Toronto Western Spasmodic Torticollis Rating Scale-PSYCH, patient-rated Clinical Global Impression - Improvement and adverse events. We used propensity score methods for statistical analysis; ten predefined confounding factors were used to build the propensity score.
Sixty-three patients were included in the non-guided group, and 60 other patients in the ultrasound-guided group. We found no difference in main and secondary outcomes between the two study groups.
This is the first direct comparison between ultrasound-guided and non-guided botulinum neurotoxin type A injections in patients with cervical dystonia. We hypothesize that ultrasound guidance made it possible to obtain the same results in the most severe (or the most demanding) patients as in the best responders. Further studies are still needed to assess the impact of botulinum neurotoxin injections into deep cervical muscles.
在颈部肌张力障碍患者中，超声引导下注射肉毒毒素具有许多理论上的优势。然而，其作用从未与非引导下的注射进行过比较。本研究的目的是根据两种方法（解剖标志的检查和触诊（非引导组）或超声引导（超声引导组））比较特发性、局灶性颈部肌张力障碍患者接受 A 型肉毒毒素治疗的结果。
我们纳入了这项单中心、前瞻性、真实世界、非随机研究中的连续患者。在注射后一个月评估结果：颈部肌张力障碍影响量表 58（主要结局）、多伦多西部痉挛性斜颈评定量表-2（疼痛和残疾子评分）、多伦多西部痉挛性斜颈评定量表-PSYCH、患者自评临床总体印象-改善和不良事件。我们使用倾向评分方法进行统计分析；使用十个预先定义的混杂因素来构建倾向评分。
非引导组纳入 63 例患者，超声引导组纳入 60 例患者。我们未发现两组主要和次要结局之间存在差异。
这是首次在颈部肌张力障碍患者中对超声引导与非引导 A 型肉毒毒素注射进行的直接比较。我们假设，超声引导使得在最严重（或最具挑战性）的患者中获得与最佳反应者相同的结果成为可能。仍需要进一步的研究来评估将肉毒毒素注射到深部颈部肌肉中的影响。
