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Possibilities of using computed tomography to treat mixed cervical dystonia with botulinum toxin type A

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The paper describes a clinical case demonstrating the possibilities of using computed tomography (CT) in the diagnosis and treatment of botulinum toxin type A (BTA) treatment of mixed cervical dystonia (CD). The poor result of initial treatment is due to the fact that the abnormally active deep muscles of the neck were beyond the reach of injection. Routine clinical examination cannot identify a concurrence of the caput and collis types of CD in most cases, which occurred in our patient. Objective examination revealed displacement of the larynx to the left from the incisura thyroidea superior, which was characteristic of the left-sided rotational caput type of CD; however, CT detected mixed CD (a concurrence of torticollis and torticaput in the left). Cervical spine CT could visualize not only the superficial, but also deep dystonic muscles of the neck, specify a botulinum toxin therapy regimen, and estimate a difference in the volumes of the normal or dystonic inferior oblique muscle of the head with further intramuscular administration of botulinum toxin. The evaluation of the efficiency and safety of BTA therapy for this disease, as well as practical guidelines for the use of CT in the diagnosis and treatment of mixed CD are given.

About the Authors

T. V. Mokina
Medical Emergency Care Hospital, Cheboksary; I.N. Ulyanov Chuvash State University, Ministry of Health of Russia, Cheboksary
Russian Federation
Department of Psychiatry, Medical Psychology, and Neurology

Yu. I. Pavlov
Republical Clinical Hospital, Cheboksary
Russian Federation

Z. A. Zalyalova
Kazan State Medical University, Ministry of Health of Russia, Kazan; Republican Clinical Diagnostic Center for Extrapyramidal Pathology and Botulinum Toxin Therapy, Kazan
Russian Federation
Department of Neurology and Rehabilitation


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For citations:

Mokina T.V., Pavlov Yu.I., Zalyalova Z.A. Possibilities of using computed tomography to treat mixed cervical dystonia with botulinum toxin type A. Neurology, Neuropsychiatry, Psychosomatics. 2016;8(2):68-73. (In Russ.)

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ISSN 2074-2711 (Print)
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