Hu Yaowen, Pan Lizhen, Su Junhui, Chen Shuzhen, Zhang Xiaolong, Pan Yougui, Jin Lingjing, Teng Fei
Department of Neurology, School of Medicine, Neurotoxin Research Center, Tongji Hospital, Tongji University, Shanghai, China.
Department of Nuclear Medicine, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China.
Front Neurol. 2022 Jul 26;13:952456. doi: 10.3389/fneur.2022.952456. eCollection 2022.
Retroform cervical dystonia (RCD), which includes retrocaput and retrocollis, is a rare form of cervical dystonia. Few reports have been published on RCD. The present study aimed to characterize the target muscles involved in RCD and the efficacy of botulinum toxin type A (BTX-A) injection.
Patients with consecutive cervical dystonia with RCD as the most problematic feature were retrospectively analyzed over a 10-year period. Target muscles were screened and confirmed based on clinical evaluation, single-photon emission computed tomography, and electromyography. In addition, efficacy and adverse events following BTX-A injection in patients with RCD were evaluated.
A total of 34 patients with RCD were included, 18 of whom presented with retrocaput and 16 with retrocollis. The most frequently injected muscles in RCD were splenius capitis (SPCa, 97.1%) and semispinalis capitis (SSCa, 97.1%), followed by levator scapulae (LS, 50.0%), rectus capitis posterior major (RCPM, 47.1%), trapezius (TPZ, 41.2%), and sternocleidomastoid muscle (SCM, 41.2%). Besides cervical muscles, the erector spinae was also injected in 17.6% of patients. Most muscles were predominantly bilaterally injected. The injection schemes of retrocaput and retrocollis were similar, possibly because in patients with retrocollis, retrocaput was often combined. BTX-A injection achieved a satisfactory therapeutic effect in RCD, with an average symptom relief rate of 69.0 ± 16.7%. Mild dysphagia (17.6%) and posterior cervical muscle weakness (17.6%) were the most common adverse events.
SPCa, SSCa, LS, RCPM, LS, and SCM were commonly and often bilaterally injected in RCD. Patients with RCD could achieve satisfactory symptom relief after BTX-A injection.
后位型颈部肌张力障碍（RCD），包括头后倾和颈后倾，是一种罕见的颈部肌张力障碍形式。关于RCD的报道很少。本研究旨在明确RCD中受累的目标肌肉以及A型肉毒毒素（BTX-A）注射的疗效。
对以RCD为最主要问题特征的连续性颈部肌张力障碍患者进行了为期10年的回顾性分析。基于临床评估、单光子发射计算机断层扫描和肌电图对目标肌肉进行筛选和确认。此外，还评估了RCD患者BTX-A注射后的疗效和不良事件。
共纳入34例RCD患者，其中18例表现为头后倾，16例表现为颈后倾。RCD中最常注射的肌肉是头夹肌（SPCa，97.1%）和头半棘肌（SSCa，97.1%），其次是肩胛提肌（LS，50.0%）、头后大直肌（RCPM，47.1%）、斜方肌（TPZ，41.2%）和胸锁乳突肌（SCM，41.2%）。除颈部肌肉外，17.6%的患者还注射了竖脊肌。大多数肌肉主要进行双侧注射。头后倾和颈后倾的注射方案相似，可能是因为在颈后倾患者中，头后倾常合并存在。BTX-A注射在RCD中取得了满意的治疗效果，平均症状缓解率为69.0±16.7%。轻度吞咽困难（17.6%）和颈后肌肉无力（17.6%）是最常见的不良事件。
在RCD中，SPCa、SSCa、LS、RCPM、LS和SCM是常见的且常进行双侧注射的肌肉。RCD患者在BTX-A注射后可获得满意的症状缓解。
