Abstract
Torticaput is the most common primary form of cervical dystonia (CD). Obliquus capitis inferior (OCI) plays a major role in ipsilateral rotation of the head. The present study aimed to use single-photon emission computed tomography (SPECT/CT) to determine the involvement of OCI in torticaput and in torticaput associated with no–no tremor. We retrospectively analyzed the SPECT/CT images of 60 patients with torticaput as the main abnormal posture and ranked the affected muscles. The affected muscles in patients with no–no tremor were also ranked. The correlation between the radioactivity of OCI and the thickness of OCI measured by ultrasonography was analyzed. The agreement between SPECT/CT and electromyography in detecting OCI was also analyzed. After sternocleidomastoid muscle (81.7%), OCI was the second most affected muscle (70.0%) in torticaput, followed by splenius capitis (63.3%). In 23 patients with no–no tremor, OCI (78.3%) and sternocleidomastoid muscle (78.3%) were the most frequently affected muscles, followed by splenius capitis (69.6%). Furthermore, bilateral muscle involvement was commonly seen in patients with no–no tremor, especially for OCI (12/23) and sternocleidomastoid muscle (11/23). A positive correlation was found between the radioactivity and thickness of OCI (r = 0.330, P < 0.001). The total agreement rate between SPECT/CT and electromyography in the diagnosis of OCI excitement was 94.0%, with kappa value = 0.866 (P < 0.001). OCI plays a critical role in torticaput and no–no tremor. SPECT/CT could be a practical tool to help clinicians detect abnormally excited OCI.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Availability of data and material
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
References
Bang MS, Lee SU (2020). In: Frontera WR, Silver JK, Rizzo TD (eds) Essentials of physical medicine and rehabilitation, 4th edn. Elsevier, Philadelphia, pp 17–21
Castagna A, Albanese A (2019) Management of cervical dystonia with botulinum neurotoxins and EMG/ultrasound guidance. Neurol Clin Pract 9(1):64–73. https://doi.org/10.1212/CPJ.0000000000000568
Chan J, Brin MF, Fahn S (1991) Idiopathic cervical dystonia: clinical characteristics. Mov Disord 6(2):119–126. https://doi.org/10.1002/mds.870060206
Chen SZ, Malam Djibo I, Wang CH, Feng L, Teng F, Li B, Pan YG, Zhang XL, Xu YF, Zhang ZY, Su JH, Ma HX, Jin LJ (2020) [99mTc]MIBI SPECT/CT for identifying dystonic muscles in patients with primary cervical dystonia. Mol Imaging Biol 22(4):1054–1061. https://doi.org/10.1007/s11307-019-01436-0
Dressler D, Pan L, Su J, Teng F, Jin L (2021) Lantox-the Chinese botulinum toxin drug-complete english bibliography and comprehensive formalised literature review. Toxins (basel) 13(6):370. https://doi.org/10.3390/toxins13060370
Feng L, Zhang ZY, Malam Djibo I, Chen SZ, Li B, Pan YG, Zhang XL, Xu YF, Su JH, Ma HX, Teng F, Jin LJ (2020) The efficacy of single-photon emission computed tomography in identifying dystonic muscles in cervical dystonia. Nucl Med Commun 41(7):651–658. https://doi.org/10.1097/MNM.0000000000001199
Fernández-de-Las-Peñas C, Mesa-Jiménez JA, Lopez-Davis A, Koppenhaver SL, Arias-Buría JL (2020) Cadaveric and ultrasonographic validation of needling placement in the obliquus capitis inferior muscle. Musculoskelet Sci Pract 45:102075. https://doi.org/10.1016/j.msksp.2019.102075
Fietzek UM, Nene D, Schramm A, Appel-Cresswell S, Košutzká Z, Walter U, Wissel J, Berweck S, Chouinard S, Bäumer T (2021) The role of ultrasound for the personalized botulinum toxin treatment of cervical dystonia. Toxins (basel) 13(5):365. https://doi.org/10.3390/toxins13050365
Hallgren RC, Andary MT, Wyman AJ, Rowan JJ (2008) A standardized protocol for needle placement in suboccipital muscles. Clin Anat 21(6):501–508. https://doi.org/10.1002/ca.20660
Jankovic J, Leder S, Warner D, Schwartz K (1991) Cervical dystonia: clinical findings and associated movement disorders. Neurology 41(7):1088–1091. https://doi.org/10.1212/wnl.41.7.1088
Jost WH (2019) Torticaput versus torticollis: clinical effects with modified classification and muscle selection. Tremor Other Hyperkinet Mov (n y). https://doi.org/10.7916/tohm.v0.647
Jost WH, Biering-Sørensen B, Drużdż A, Kreisler A, Pandey S, Sławek J, Tatu L (2020a) Preferred muscles in cervical dystonia. Neurol Neurochir Pol 54(3):277–279. https://doi.org/10.5603/PJNNS.a2020.0022
Jost WH, Tatu L, Pandey S, Sławek J, Drużdż A, Biering-Sørensen B, Altmann CF, Kreisler A (2020b) Frequency of different subtypes of cervical dystonia: a prospective multicenter study according to Col-Cap concept. J Neural Trans (vienna) 127(1):45–50. https://doi.org/10.1007/s00702-019-02116-7
Jost WH, Drużdż A, Pandey S, Biering-Sørensen B, Kreisler A, Tatu L, Altmann CF, Sławek J (2021) Dose per muscle in cervical dystonia: pooled data from seven movement disorder centres. Neurol Neurochir Pol 55(2):174–178. https://doi.org/10.5603/PJNNS.a2021.0005
Kaymak B, Kara M, Gürçay E, Özçakar L (2018) Sonographic guide for botulinum toxin injections of the neck muscles in cervical dystonia. Phys Med Rehabil Clin N Am 29(1):105–123. https://doi.org/10.1016/j.pmr.2017.08.009
Kreisler A, Gerrebout C, Defebvre L, Demondion X (2021) Accuracy of non-guided versus ultrasound-guided injections in cervical muscles: a cadaver study. J Neurol 268(5):1894–1902. https://doi.org/10.1007/s00415-020-10365-w
Kyparos D, Arsos G, Kyparos A, Georga S, Petridou A, Sotiriadou S, Mougios V, Matziari C (2008) Effect of aerobic training on 99mTc-methoxy isobutyl isonitrile (99mTc-sestamibi) uptake by myocardium and skeletal muscle: implication for noninvasive assessment of muscle metabolic profile. Acta Physiol (oxf) 193(2):175–180. https://doi.org/10.1111/j.1748-1716.2007.01825.x
Misra VP, Ehler E, Zakine B, Maisonobe P, Simonetta-Moreau M, INTEREST IN CD group (2012) Factors influencing response to Botulinum toxin type A in patients with idiopathic cervical dystonia: results from an international observational study. BMJ Open 2(3):e000881. https://doi.org/10.1136/bmjopen-2012-000881
Miyamoto S, Ide T, Takemura N (2010) Risks and causes of cervical cord and medulla oblongata injuries due to acupuncture. World Neurosurg 73:735–741. https://doi.org/10.1016/j.wneu.2010.03.020
Pandey S, Kreisler A, Drużdż A, Biering-Sørensen B, Sławek J, Tatu L, Jost WH (2020) Tremor in idiopathic cervical dystonia—possible implications for botulinum toxin treatment considering the Col-Cap classification. Tremor Other Hyperkinet Mov (n Y) 10:13. https://doi.org/10.5334/tohm.63
Reichel G (2011) Cervical dystonia: a new phenomenological classification for botulinum toxin therapy. Basal Ganglia 1(1):5–12. https://doi.org/10.1016/j.baga.2011.01.001
Reichel G (2012) Dystonias of the neck: clinico-radiologic correlations, dystonia—the many facets. Raymond Rosales (ed), ISBN: 978-953-51-0329-5, InTech. http://www.intechopen.com/books/dystonia-the-many-facets/dystonias-of-the-neck-clinico-radiologiccorrelations
Schramm A, Huber D, Möbius C, Münchau A, Kohl Z, Bäumer T (2017) Involvement of obliquus capitis inferior muscle in dystonic head tremor. Parkinsonism Relat Disord 44:119–123. https://doi.org/10.1016/j.parkreldis.2017.07.034
Stacy M (2008) Epidemiology, clinical presentation, and diagnosis of cervical dystonia. Neurol Clin 26(Suppl 1):23–42. https://doi.org/10.1016/s0733-8619(08)80003-5
Tighe AP, Schiavo G (2013) Botulinum neurotoxins: mechanism of action. Toxicon 67:87–93. https://doi.org/10.1016/j.toxicon.2012.11.011
Van Gerpen JA, Matsumoto JY, Ahlskog JE, Maraganore DM, McManis PG (2000) Utility of an EMG mapping study in treating cervical dystonia. Muscle Nerve 23(11):1752–1756. https://doi.org/10.1002/1097-4598(200011)23:11%3c1752::aid-mus12%3e3.0.co;2-u
Walter U, Dudesek A, Fietzek UM (2018) A simplified ultrasonography-guided approach for neurotoxin injection into the obliquus capitis inferior muscle in spasmodic torticollis. J Neural Trans (vienna) 125(7):1037–1042. https://doi.org/10.1007/s00702-018-1866-4
Funding
This study was supported by Medical Innovation Project of Shanghai Science and Technology Commission (20Y11906000), Clinical Science and Technology Innovation Project of Shanghai Shen-kang Hospital Development Center (SHDC12020119), Shanghai Municipal Science and Technology Committee of Shanghai outstanding academic leaders’ plan (20XD1403400).
Author information
Authors and Affiliations
Contributions
JS, YH and IMD: acquisition and analysis of the data. SC: SPECT/CT scan and analysis. YP and XZ: BTX-A injection. LP and LJ: revision of the manuscript. FT: design of the study, analysis of the data, and drafting of the manuscript.
Corresponding author
Ethics declarations
Conflict of interests
None.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Su, J., Hu, Y., Djibo, I.M. et al. Pivotal role of obliquus capitis inferior in torticaput revealed by single-photon emission computed tomography. J Neural Transm 129, 311–317 (2022). https://doi.org/10.1007/s00702-022-02469-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00702-022-02469-6