Dystonia

INDEX

             Anterocollis                                          Anterocaput                                                Forward Sagittal  Shift

From: Jost WH, Tatu L. Selection of Muscles for Botulinum Toxin Injections in Cervical Dystonia. Mov Disord Clin Pract 2015; 2: 224–6.

Anterocollis
Anterocollis affects muscles which originate from or insert at the cervical spine, resulting in abnormal posture of the cervical spine: therefore, the neck is tilted forwards in relation to the thoracic spine; the angle between the neck and head is normal1.

Anterocaput
Head and neck form too great an angle; the angle between the cervical and thoracic spine is normal2.

Distinguishing anterocaput and and anterocollis
Analysis of forward flexion (differentiation between anterocollis and anterocaput) can be accomplished by observation from the side of the respective angles between:

Figure 1. Anterocollis and Anterocaput

From: Reichel G. Dystonias of the Neck: Clinico-Radiologic Correlations. In: Dystonia - The Many Facets. InTech, 2012


 

ANTEROCOLLIS

Figure 1. A patient with anterocollis. 

 

Patient Image

 

From: Finsterer J, Maeztu C, Revuelta GJ, Reichel G, Truong D. Collum-caput (COL-CAP) concept for conceptual anterocollis, anterocaput, and forward sagittal shift. J Neurol Sci [Internet] 2015;355(1–2):37–43.

Figure 2. A patient with anterocollis. 

 

Patient Image

From: Reichel G. Cervical dystonia: A new phenomenological classification for botulinum toxin therapy. Basal Ganglia [Internet] 2011;1(1):5–12. 




TREATMENT

Many experts consider anterocaput/anterocollis the most difficult pattern of cervical dystonia to successfully manage with botulinum toxin3.
In anterocaput/anterocollis, the targeting challenges associated with injection of the deep flexors has led many clinicians to limit injections to the more easily accessible superficial flexor muscles, the sternocleidomastoids, and scalenus anterior.  However, this traditional approach to the treatment of anterocollis is only occasionally effective and can also result in dysphagia. For example:

Injecting only these superficial flexor muscles may provide only limited or no benefit for those patients whose dystonic movements or postures are caused by longus capitis and longus colli over-activity.  In all patients with anterocaput and in some patients with anterocollis, injection of the longus capitis or longus colli may be required to improve symptoms.

Injections of longus colli are detailed here:  Section: Backward Sagittal Shift


Alternative scheme for injection: (After: Jost WH, Tatu L. Selection of Muscles for Botulinum Toxin Injections in Cervical Dystonia. Mov Disord Clin Pract 2015;2(3):224–6)

  1. Scalenus medius/posterior
  2. Levator scapulae
  3. Longus colli (secondary)

 


 

ANTEROCAPUT

Figure 3. A patient with anterocaput.

 

Patient Image

From: Finsterer J, Maeztu C, Revuelta GJ, Reichel G, Truong D. Collum-caput (COL-CAP) concept for conceptual anterocollis, anterocaput, and forward sagittal shift. J Neurol Sci 2015; 355: 37–43.
 

Figure 4. A patient with anterocaput.

 

Patient Image

From: Finsterer J, Revuelta GJ. Anterocollis and anterocaput. Clin Neurol Neurosurg 2014; 127: 44–53.

Figure 5. A patient with anterocaput.

 

Patient Image

From: Reichel G. Cervical dystonia: A new phenomenological classification for botulinum toxin therapy. Basal Ganglia 2011; 1: 5–12.



TREATMENT (After: Jost WH, Tatu L. Selection of Muscles for Botulinum Toxin Injections in Cervical Dystonia. Mov Disord Clin Pract 2015;2(3):224–6)

BILATERAL

  1. Longus capitis
  2. Levator scapulae
  3. Sternocleidomastoid (Secondary)

 

 

 

 

 

 

 

 

 

 

 

 

References

1            Finsterer J, Revuelta GJ. Anterocollis and anterocaput. Clin Neurol Neurosurg 2014; 127: 44–53.

2            Finsterer J, Maeztu C, Revuelta GJ, Reichel G, Truong D. Collum-caput (COL-CAP) concept for conceptual anterocollis, anterocaput, and forward sagittal shift. J Neurol Sci 2015; 355: 37–43.

3            Farrell M, Karp BI, Kassavetis P, et al. Management of Anterocapitis and Anterocollis: A Novel Ultrasound Guided Approach Combined with Electromyography for Botulinum Toxin Injection of Longus Colli and Longus Capitis. Toxins (Basel) 2020; 12

4            Reichel G. Cervical dystonia: A new phenomenological classification for botulinum toxin therapy. Basal Ganglia 2011; 1: 5–12.

5            Jost WH, Tatu L. Selection of Muscles for Botulinum Toxin Injections in Cervical Dystonia. Mov Disord Clin Pract 2015; 2: 224–6.