{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T22:02:39Z","timestamp":1788386559316,"version":"build-2803163510"},"reference-count":28,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,9,28]],"date-time":"2022-09-28T00:00:00Z","timestamp":1664323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Aim: The aim of this study was to evaluate the efficacy of ultrasound guidance (US) in the treatment of cervical dystonia (CD) with botulinum neurotoxin type A (BoNT-A) injections in comparison to anatomical landmarks (AL). To date, US is routinely used in many centers, but others deny its usefulness. Materials and Methods: Thirty-five patients (12 males, 23 females) with a clinical diagnosis of CD were included in the study. Intramuscular administration of BoNT-A was performed using either US guidance, or with AL, in two separate therapeutic sessions. The efficacy of BoNT-A administration was assessed with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), Tsui modified scale, Craniocervical Dystonia Questionnaire (CDQ-24) and Clinical Global Impression\u2014Improvement scale (CGI-I). Additionally, patients at therapeutic sessions were digitally recorded and evaluated by two blinded and independent raters. Results: A significant decrease in total TWSTRS, severity subscale TWSTRS, Tsui score, and CDQ-24 was found in both the AL and US group; however, in the TWSTRS disability and pain subscales, a significant decrease was found only in the US group. Moreover, US guided treatment also resulted in a greater decrease in TWSTRS, Tsui score and CDQ-24 compared to anatomical landmarks use only. Conclusions: US guidance might be helpful in improving the results of BoNT-A injections in cervical dystonia, reducing associated pain and disability; however, more studies are needed to evaluate its clinical efficacy.<\/jats:p>","DOI":"10.3390\/toxins14100674","type":"journal-article","created":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T01:23:16Z","timestamp":1664414596000},"page":"674","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Does Ultrasound Guidance Improve the Effectiveness of Neurotoxin Injections in Patients with Cervical Dystonia? (A Prospective, Partially-Blinded, Clinical Study)"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1928-1941","authenticated-orcid":false,"given":"Ma\u0142gorzata","family":"Ty\u015blerowicz","sequence":"first","affiliation":[{"name":"Department of Neurophysiology, Copernicus Memorial Hospital, 93-513 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5517-9875","authenticated-orcid":false,"given":"Jaros\u0142aw","family":"Dulski","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA"},{"name":"Department of Neurology, St. Adalbert Hospital, Copernicus PL Ltd., 80-462 Gdansk, Poland"},{"name":"Division of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, 80-211 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justyna","family":"Gawryluk","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 41-808 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaros\u0142aw","family":"S\u0142awek","sequence":"additional","affiliation":[{"name":"Department of Neurology, St. Adalbert Hospital, Copernicus PL Ltd., 80-462 Gdansk, Poland"},{"name":"Division of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, 80-211 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,28]]},"reference":[{"key":"ref_1","unstructured":"Brin, M.F., Comella, C., Jankovic, J., and Philadelphia, P.A. (2004). Pathophysiology of dystonia. Dystonia: Etiology, Clinical Features, and Treatment, Lippincott, Williams and Wilkins. [1st ed.]."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1212\/01.wnl.0000311389.26145.95","article-title":"Therapeutics and Technology Assessment Sucommittee of the American Acadamy of Neurology. Assessment: Botulinum neurotoxin for the treatment of movement disorders (an evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology","volume":"70","author":"Simpson","year":"2008","journal-title":"Neurology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/j.1468-1331.2010.03042.x","article-title":"EFNS guidelines on diagnosis and treatment of primary dystonias","volume":"18","author":"Albanese","year":"2011","journal-title":"Eur. J. Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/S0733-8619(08)80005-9","article-title":"Treatment recommendations and practical applications of botulinum toxin treatment of cervical dystonia","volume":"26","author":"Swope","year":"2008","journal-title":"Neurol Clin."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Jankovic, J., Adler, C.H., Charles, P.D., Comella, C., Stacy, M., Schwartz, M., Sutch, S.M., Brin, M.F., and Papapetropoulos, S. (2011). Rationale and design of a prospective study: Cervical Dystonia Patient Registry for Observation of Ona Botulinumtoxin a Efficacy (CD PROBE). BMC Neurol., 11.","DOI":"10.1186\/1471-2377-11-140"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1111\/j.1468-1331.2006.01440.x","article-title":"Treatment of cervical dystonia with botulinum toxins","volume":"13","author":"Comella","year":"2006","journal-title":"Eur. J. Neurol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1007\/s00415-016-8136-x","article-title":"Botulinum toxin treatment failures in cervical dystonia: Causes, management and outcomes","volume":"263","author":"Jinnah","year":"2016","journal-title":"J. Neurol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"232","DOI":"10.5603\/PJNNS.a2020.0021","article-title":"Cervical dystonia\u2014Imroving the effectiveness of botulinum toxin therapy","volume":"54","author":"Adamkiewicz","year":"2020","journal-title":"Neurol. Neurochir. Pol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"125","DOI":"10.5603\/PJNNS.a2021.0029","article-title":"Botulinum neurotoxin in cervical dystonia revisited\u2014Recent advances and unanswered questions","volume":"55","author":"Jost","year":"2021","journal-title":"Neurol. Neurochir. Pol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1212\/WNL.41.7.1088","article-title":"Cervical dystonia: Clinical findings and associated movement disorders","volume":"41","author":"Jankovic","year":"1991","journal-title":"Neurology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1055\/s-0028-1109416","article-title":"The phenomenology of cervical dystonia Proposed New treatment strategy with botulinum toxin","volume":"77","author":"Reichel","year":"2009","journal-title":"Fortschr. Neurol. Psychiat."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"277","DOI":"10.5603\/PJNNS.a2020.0022","article-title":"Preferred muscles in cervical dystonia","volume":"54","author":"Jost","year":"2020","journal-title":"Neurol. Neurochir. Pol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1002\/mds.870100619","article-title":"Cervical dystonia and botulinum treatment: Is electromyographic guidance necessary?","volume":"10","author":"Speelman","year":"1995","journal-title":"Mov. Disord."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2142","DOI":"10.1111\/ene.14415","article-title":"Anatomy-guided injections of botulinum neurotoxin in neck muscles: How accurate is needle placement?","volume":"27","author":"Kreisler","year":"2020","journal-title":"Eur. J. Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1002\/mus.23409","article-title":"Elimination of dysphagia using ultrasound guidance for botulinum toxin injections in cervical dystonia","volume":"46","author":"Hong","year":"2012","journal-title":"Muscle Nerve"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S20","DOI":"10.1016\/j.parkreldis.2011.06.015","article-title":"Treatment of complex cervical dystonia with botulinum toxin: Involvement of deep-cervical muscles may contribute to suboptimal responses","volume":"17","author":"Bhidayasiri","year":"2011","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1002\/mds.25024","article-title":"Sonographic guidance provides a low-risk approach to the longus colli muscle","volume":"27","author":"Fujimoto","year":"2012","journal-title":"Mov. Disord."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1790","DOI":"10.2967\/jnumed.107.044024","article-title":"Localization of dystonic muscles with 18F-FDG PET\/CT in idiopathic cervical dystonia","volume":"48","author":"Sung","year":"2007","journal-title":"J. Nucl. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"996","DOI":"10.2214\/AJR.08.1535","article-title":"Initial experience with imaging-guided intramuscular botulinum toxin injection on patients with idiopathic cervical dystonia","volume":"192","author":"Lee","year":"2009","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_20","first-page":"718","article-title":"Injection into the Longus Colli Muscle via the Thyroid Gland","volume":"9","author":"Jost","year":"2019","journal-title":"Tremor Other Hyperkinet. Mov."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1097\/RUQ.0000000000000226","article-title":"Ultrasound and Electromyography Guidance for Injection of the Longus Colli with Botulinum toxin for the Treatment of Cervical Dystonia","volume":"32","author":"Allison","year":"2016","journal-title":"Ultrasound Q."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/j.neurol.2021.11.005","article-title":"Does ultrasound-guidance improve the outcome of botulinum toxin injections in cervical dystonia?","volume":"178","author":"Kreisler","year":"2022","journal-title":"Rev. Neurol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1007\/s00702-016-1621-7","article-title":"Anatomy and cervical dystonia: \u201cDysfunction follows form\u201d","volume":"124","author":"Tatu","year":"2017","journal-title":"J. Neural. Transm."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1007\/s00702-014-1356-2","article-title":"Relevance of sonography for botulinum toxin treatment of cervical dystonia: An expert statement","volume":"122","author":"Schramm","year":"2015","journal-title":"J. Neural. Transm."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1007\/s00702-020-02220-z","article-title":"Dysphagia in cervical dystonia patients receiving optimised botulinum toxin therapy: A single-center retrospective cohort study","volume":"127","author":"Kutschenko","year":"2020","journal-title":"J. Neural. Transm."},{"key":"ref_26","first-page":"144","article-title":"German Dystonia Study Group","volume":"44","author":"Kessler","year":"1999","journal-title":"J. Neurol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.parkreldis.2014.09.034","article-title":"Factors influencing secondary non-response to botulinum toxin type A injections in cervical dystonia","volume":"21","author":"Ferreira","year":"2015","journal-title":"Park. Relat. Disord."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1002\/mdc3.12172","article-title":"Selection of Muscles for Botulinum Toxin Injections in Cervical Dystonia","volume":"7","author":"Jost","year":"2015","journal-title":"Mov. Disord. Clin. Pract."}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/14\/10\/674\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:41:10Z","timestamp":1760143270000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/14\/10\/674"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,28]]},"references-count":28,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["toxins14100674"],"URL":"https:\/\/doi.org\/10.3390\/toxins14100674","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,28]]}}}