The Therapeutic Use Of EMG-Guided Injection Of Botulinum Toxin A (BTX-A) In Patients With Cervical Dystonia

Background:Spasmodic torticollis is the most common form of adult-onset focal dystonia,with a prevalence of approximately 9 cases per 100,000 population.The etiology of CD is unknown,there is no specific drugs or surgical methods.Since the 1980s,BTX-A has obtained good curative effects in the treatment of focal muscle spasm such as biepharnspasm and hemifacial spasm,the foreigners gradually start treatment in patients with CD.Since the 1990s,China has put domestic BTX-A into practice in the clinical treatment.Numerous studies have shown that the efficacy and safety of BTX-A injection therapy,which can be used as the first choice for the treatment of CD.But the overall effect is lower than the other dystonia(such as blepharospasm,hemifacial spasm).Objective:Observe the therapeutic use of EMG-Guided injection of botulinum toxin A (BTX-A) in patients with cervical dystonia,and the relationship between the treatment efficacy and gender,number of previous treatment,age,duration,type,etc.Different types of cervical dystonia with BTX-A treatment at the most markedly time(two weeks), the patients with poor effect come to the hospital,the Specialist find out the muscle which is missing in the first visit or underdosage.And to explore in the patients with cervical dystonia,follow-up at 2 weeks,Complement the BTX-A dose,whether can improve the Clinical Effectiveness.Methods:In 51 cases of cervical dystonia,record the spasmodic muscles At the first visit,determine the amount of BTX-A in accordance with the size and scope of the number of affected muscles,BTX-A by the EMG-guided percutaneous injection of spasmodic hypertrophy muscles.For the patient with poor efficacy at the follow-up visit, the expert assesses the patient again to find the muscles that still cramping(missing in the first visit or inadequate doses of the muscle),injection of BTX-A again,the time interval is 2 week.We grade the patients refering to Tsui's criterion Before and after treatment.Results:2 weeks later,according to out-patient follow-up visits and telephone follow-up,refer to Tsui's criterion.21 cases(41.2%) have marked effect,a notable improvement in 22 cases(43.1%),8 cases ineffective(15.7%),none take a turn for the worse,total effective rate was 84.3%.We take single-sample t test,paired t test design and paired samples of non-parametric test before and after the BTX-A treatment,p＜0.001,which has shown that EMG-guided local injection of BTX-A treatment of cervical dystonia is effective.12 patients were injected BTX-A once again after 2 weeks. 8 cases of localized type(20.5%),2 cases of segmental type(28.6%),2 cases of systemic type(40%),according to Tsui's criterion,after 2 weeks,8 cases(20.5%) have marked effect, a notable improvement in 2 cases(16.7%),2 cases ineffective(16.7%),none take a turn for the worse.In this study,a total of 51 patients,12 patients were injected BTX-A once again after 2 weeks,a total of 23 cases have marked effect(45.1%),a notable improvement in 21 cases(41.2%),2 cases ineffective(13.7%),none take a turn for the worse.,total effective rate was 86.3%,which is 2%higher than a single treatment (84.3%).We take the design paired t test of SPSS16.0 statistical software before and after the BTX-A retreatment,p=0.002,which showed that EMG-guided local reinjection of BTX-A treatment of cervical dystonia after two weeks has significant differences. Conclusion:EMG-guided BTX-A injection treatment of CD is effective,easy to operate and can be used as the preferred treatment of the disease.The treatment efficacy has nothing to do with gender,number of previous treatment,age,duration,type,etc..the muscles that still cramp are composed of inadequate dose of such musles which play a major role in most cases and deep muscle witch can be easily missed.We can come to the conclusion that 2-week follow-up visits may enhance the effectiveness of treatment.