nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2021-6-124-131nnp-1717Research ArticleCLINICAL OBSERVATIONSКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯNovel approaches to the treatment of cervical dystonia. The concept of dual navigation controlНовые подходы к лечению цервикальной дистонии. Концепция двойного навигационного контроляhttps://orcid.org/0000-0001-5762-5632КоваленкоА. П.KovalenkoA. P.

 Россия, 194044, Санкт-Петербург, ул. Академика Лебедева, 6 

 6, Academician Lebedev St., Saint Petersburg 194044, Russia 

kvlnko73@gmail.comhttps://orcid.org/0000-0001-8718-7266ЗаляловаЗ. А.ZalyalovaZ. A.

 Россия, 420012, Казань, ул. Бутлерова, 49 

 49, Butlerov St., Kazan 420012, Russia 

https://orcid.org/0000-0002-8849-680XИволгинА. Ф.IvolginA. F.

 Россия, 143420, Московская область, Красногорск, п. Новый, 1 

  1, p. Noviy, Krasnogorsk 143420, Moscow region, Russia 

ФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова»РоссияS.M. Kirov Military Medical AcademyRussian FederationФГБОУ ВО «Казанский государственный медицинский университет» Минздрава РоссииРоссияKazan State Medical University, Ministry of Health of RussiaRussian FederationФГБУ «3-й Центральный военный клинический госпиталь им. А.А. Вишневского» Минобороны РоссииРоссияA.A. Vishnevsky 3rd Central Military Clinical Hospital, Ministry of Defense of RussiaRussian Federation202116122021136124131Copyright © Kovalenko A.P., Zalyalova Z.A., Ivolgin A.F., 20212021Коваленко А.П., Залялова З.А., Иволгин А.Ф.Kovalenko A.P., Zalyalova Z.A., Ivolgin A.F.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/1717

Сervical dystonia (CD) is the most common type of focal dystonia (up to 50% of all dystonia cases). Botulinum neurotoxin (BoNT) injections is the treatment choice for CD. However, the effectiveness and tolerability of botulinum therapy in CD depends on the correct choice of target muscles and the accuracy of the BoNT injection. The publication presents literature data and our own clinical experience regarding the use of navigation in BoNT injections in CD.According to the majority of authors, the use of navigation equipment, such as ultrasound (US) and electromyography (EMG), definitely increases the effectiveness of CD treatment and reduces the likelihood of adverse events. For the first time, an algorithm for the diagnosis and treatment of CD is proposed, based on the use of the method of «double- (EMG and US) guided navigation», a variant for determining the comparative activity of muscles by the intensity of the EMG signal and the design of an individual «passport» of the CD. The possibilities of analyzing the US of muscles, drawing up an accurate treatment regimen, targeted administration of BoNT, and using a non-injectable EMG electrode are shown. We present 4 clinical cases demonstrating the advantages of the double- (EMG+US) guided navigation method over the EMG-guided navigation for injection. The proposed algorithm for the diagnosis and treatment of CD makes it possible to increase the effectiveness of treatment, optimize the costs of BoNT and diagnostic equipment (injection EMG needle).

Цервикальная дистония (ЦД) – самый распространенный тип фокальной дистонии (до 50% случаев от числа всех дистоний). Основной метод лечения ЦД – инъекции ботулинического нейротоксина (БоНТ). Однако эффективность и переносимость ботулинотерапии при ЦД в первую очередь зависят от определения таргетных мышц и точности мышечных инъекций БоНТ. В публикации представлены данные литературы и собственный клинический опыт использования навигации при инъекциях БоНТ при ЦД.По мнению большинства авторов, применение ультразвукового (УЗ-) навигационного оборудования, а также аппаратуры для электромиографии (ЭМГ) объективно повышает эффективность лечения ЦД и снижает вероятность развития нежелательных явлений. Впервые предложены алгоритм диагностики и лечения ЦД, основанный на использовании метода двойного (ЭМГ- и УЗ-) навигационного контроля, вариант определения сравнительной активности мышц по интенсивности ЭМГ-сигнала и оформление индивидуального «паспорта» ЦД. Показаны возможности анализа УЗ-картины мышц, составления точной схемы лечения, таргетного введения БоНТ, использования неинъекционного ЭМГ-электрода. Представлены четыре клинических случая, демонстрирующих преимущества метода двойного (ЭМГ- и УЗ-) контроля перед навигационным способом введения и проведения инъекции под ЭМГ-контролем. Предложенный алгоритм диагностики и лечения ЦД позволяет повысить эффективность лечения, оптимизировать затраты на препараты БоНТ и диагностическое оборудование (инъекционную ЭМГ-иглу).

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The authors declare that there are no conflicts of interest present.