Impact of posterior deep neck muscle treatment on cervical dystonia: Necessity to differentiate between abnormal positions of head and neck

Aim of the study: To demonstrate the efficacy of botulinum toxin A injections into the posterior deep neck muscles (pDNMs) in treatment of patients with cervical dystonia (CD) with a retrocollis component. Methods: Retrospective analysis of our patient data bank (Access). Methods: Retrospective analysis of our patient data bank (Access). Patients: Severity of CD was analyzed in patients who had been treated in our ambulance without injections of the pDNMs and in whom pDNM treatment was initiated because of otherwise unsatisfactory treatment effects (retrospective study I). In addition, two subgroups of de novo patients were analyzed and compared. In the first group treatment was initiated without injections of the pDNMs, in the second group pDNMs were injected from the very beginning (retrospective study II). Results: Specific treatment of pDNMs in addition to treatment of standard muscles led to an additional improvement of severity of CD. Conclusions: If CD patients with a retrocollis component do not respond well to injections of standard muscles, injections of the pDNMs should be considered. However, to actually evaluate the clinical benefit resulting from pDNM injections, new scales and scores have to be developed since the existing clinical scoring tools do not differentiate between movements of the head and the neck. (C) 2012 Published by Elsevier GmbH.