• Journal of Korean Neurosurgical Society
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• v.46 no.4
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• pp.346-350
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• 2009

Objective : The purpose of this study was to analyze in detail the relationship between outcome and time course of effect in medically refractory primary cervical dystonia (CD) with phasic type that was treated by bilateral globus pallidus internus (Gpi) deep brain stimulation (DBS). Methods : Six patients underwent bilateral implantation of DBS into the Gpi under the guide of microelectrode recording and were followed for $18.7{\pm}11.1$ months. The mean duration of the CD was $5.8{\pm}3.4$ years. The mean age at time of surgery was $54.2{\pm}10.2$ years. Patients were evaluated with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and relief scale using patient self-reporting. Results : The TWSTRS total scores improved by 64.5%, 65.5%, 75.8%, and 76.0% at 3, 6, 12 months, and at the last available follow-up after surgery, respectively. Statistically significant improvements in the TWSTRS scores were observed 3 months after surgery (p=0.028) with gradual improvement up to 12 months after surgery, thereafter, the improvement was sustained. However, there was no statistically significant difference between the scores at 3 and 12 months. Subjective improvement reported averaged $81.7{\pm}6.8%$ at last follow-up. Mild dysarthria, the most frequent adverse event, occurred in 3 patients. Conclusions : Our results show that the bilateral Gpi-DBS can offer a significant therapeutic effect from 3 months postoperatively in patients with primary CD with phasic type, without significant side effects.

• Journal of Korean Medicine Rehabilitation
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• v.29 no.4
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• pp.109-115
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• 2019

Cervical dystonia (CD) is a disorder characterized by sustained or intermittent, involuntary muscle contractions which cause twisting, repetitive movements and abnormal postures. In this case report, a CD patients was treated with transfer energy capacitive and resistive (TECAR) therapy and conventional Korean medicine, which consists of acupuncture, Chuna manual medicine, pharmacopuncture and herbal medicine. For outcome measures, this study evaluated Cobb's angle, EuroQol five dimension scale (EQ-5D), numerical rating scale (NRS), neck disabillity index (NDI) and cervical range of motion. As a result, improvements were found in Cobb's angle ($18.65^{\circ}$ to $15.90^{\circ}$), EQ-5D score (0.808 to 0.862), NRS (5 to 3), NDI (16 to 8) and angle of cervical lateral bending ($15^{\circ}$ to $25^{\circ}$). In conclusion, this study shows that combined therapy of conventional Korean medicine treatment and TECAR therapy can be effective for CD patients.

• Journal of Korean Neurosurgical Society
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• v.37 no.5
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• pp.350-353
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• 2005

Objective: Various methods of treatment for idiopathic cervical dystonia have been tried in the past with unsatisfactory results. The authors report cases of five patients who underwent selective peripheral denervation for spasmodic torticollis. Methods: Between July 2002 and December 2003, 5 patients underwent surgery at St. Mary's Hospital for spasmodic torticollis. Age of the patient at the onset of symptoms ranged from 29 to 56years (mean 43.75years). Selective peripheral denervation(SPD) was performed at 7 to 11 months after the onset of symptoms (mean 8.75 months). A patient was considered to be the candidate for surgery if conservative methods were unsuccessful and symptoms persisted for longer than 7months. In addition, 2patients who refused treatment with botulinum toxin were also enrolled in this study. Results: Although one patient underwent reoperation, all of the five patients' symptoms were improved after the operation. Clinically, patients with retrocollis showed better improvement than laterocollis patients. Conclusion: Although injection of botulinum toxin is the first-choice in treatment modality, when surgery is required, selective peripheral denervation provides good results with minimum side effects.

• Archives of Plastic Surgery
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• v.38 no.2
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• pp.207-211
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• 2011

Purpose: Surgery for thyroid gland requires skin incisions that can result in postsurgical neck scar. To overcome this, many surgeons performed a endoscopic thyroidectomy. But, this approach had a some problems. One of postoperative problems, iatrogenic cervical dystonia (CD) may occur. At common, CD is defined as a syndrome characterized by prolonged muscle contraction causing twisting, repetitive movements or abnormal posture. Botulinum toxin A (BTA, Botox$^{(R)}$, Allergan, Irvine, CA, USA) is well known treatment agent in the treatment of CD. So, the authors applied BTA injection in rare case with iatrogenic CD resulting in endoscopic thyroidectomy. Methods: A 43-year-old female had endoscopic subtotal thyroidectomy operation 3 years ago. She had symptoms such as progressive cervical pain, abnormal neck posture, depression, and sleep difficulty. About 1 year later, the patient who had previous myomectomy of the clavicular head of sternocleidomastoid muscle, however, symptoms were not improved. And then the patient received BTA therapy in our department. The 2 units per 0.1 mL solution was administered in a 1 mL tuberculin syringe. Results: The dose of BTA used in the patient was 36 units for vertical platysmal bands, superficially, and 10 units for ipsilateral sternocleidomastoid muscle, intramuscularly. After 2 weeks, additional the dose of BTA used in the patient was 5 points for remained scar bands, superficially. Complications related to injection such as significant swallowing difficulties, neck muscle weakness, or sensory change were not observed. In 9 months follow-up, the patient maintained a good result from the method of BTA injection alone. Conclusion: The basic concept is selective denervation for the hyperactive individual muscles and scar bands. We conclude that BTA is an effective and safe treatment for CD despite the iatrogenic and complex presentation of this complication.

• Journal of Physiology & Pathology in Korean Medicine
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• v.27 no.1
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• pp.34-42
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• 2013

Our study is to review Chinese traditional medicine's journals about the diagnosis and treatment of spasmodic torticollis such as category, syndrome differentiation, acupoints of treatment, and herbal medicine. The journal search was performed using the search engine of China Academic Journal (CAJ) and China Doctor/Master's Dissertation (CDMD) in China National Knowledge Infrastructure (CNKI) from January 1982 to October 2012. Searching key words were the diverse combination of "spasmodic torticollis", "cervical dystonia", "Chinese traditonal medicine", "herbal medicine", "acupuncture", and "syndrome differentiation". The inclusion criteria was all kinds of journals including Chinese traditional medicine approach except for experiment study. The category, syndrome differentiation, acupoints of treatment, and herbal medicine from finally selected journals were extracted and summarized. The fourty-seven Chinese journals were selected finally. The category was divided into wind syndrome, trembling syndrome, convulsive syndrome, and convulsions. The syndrome differentiation was classified as internal stirring of liver wind, yin-blood depletion, invasion of external contraction, uncontrol of governor vessel, internal obstruction of phlegm turbidity, dual deficiency of qi and blood, and blood stasis due to qi stagnation. The combination of acupoints to unblock the meridian and dissipate binds and to tonify governor vessel and repel tremor was mainly used in acupuncture treatment. Galgun-tang or galgun-tanggami was primarily used and the others were the prescriptions to tonify liver and kidney, to calm convulsion, and to dispeling wind-phlegm. We suggests that spasmodic torticollis could be treated using Korean medicine's approach in Korea.

• Journal of Dental Rehabilitation and Applied Science
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• v.29 no.4
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• pp.391-398
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• 2013

Botulinum toxin has been used for treating strabismus, blepharospasm, cerebral palsy, cervical dystonia, hyperhydrosis, facial wrinkle and chronic migraine under US Food and Drug administration approval. Also it has been tried spasticity-induced pain, post-herpetic neuralgia, myofascial pain and aphthous ulcer as off-label use. In this study, we reviewed recent studies that suggested effects of botulinum toxin on snoring and sleep apnea.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.19 no.1
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• pp.79-83
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• 2013

Background: Spasmodic torticollis is a disorder that is described by sustained muscle contractions causing repetitive and twisting movements, and abnormal postures in a single body region. The purpose of this case is to describe the manual therapy for a patient with spasmodic torticollis. Methods: The patient was a 64 years old man with an 3 month history of left side laterocollis spasmodic torticollis. No known genetic history or trauma. Prior to intervention, his score on the Western Spasmodic Torticollis Rating Scale (TWSTRS) severity score was 24, disability score was 20, pain score was 11. There is a noticeable distinction between left and right side cervical range of motion. The intervention consisted of manual therapy (MET, PNF) 3 times per week for the treatment during 4 weeks. Results: After intervention for 4weeks, his TWSTRS score and range of motion was improved quite a bit before therapeutic exercise. But symptoms are not improving sufficiently fast. Conclusions: Manual therapy is that MET and PNF is effective in improving for patient had spasmodic torticollis with laterocollis of neck.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.23 no.2
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• pp.104-110
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• 2012

The usages of botulinum toxin were most commonly for the treatment of spasmodic dysphonia in the otolaryngology field. It has been not only widely used in otolaryngology-Head Neck surgery but also plastic surgery, ophthalmology, rehabilitation medicine, and orthopedics. Now botulinum toxin is used such as blepharospasm (excessive blinking), strabismus, cosmetic, muscle spasms, upper motor neuron syndrome, severe primary axillary hyperhidrosis (excessive sweating), cervical dystonia (spasmodic torticollis), chronic migraine, bruxism, and achalasia. The indication of this drug still gradually expanding with the times. In this articles, the author will demontrate how to use the botulinum toxin for treating cricopharyngeal spasm, arytenoid dislocation, sialocele, Frey syndrome, contact granuloma, bilateral vocal fold paralysis, and mutaional falsetto instead of conventional surgical treatment.

• The Journal of the Korean dental association
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• v.48 no.12
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• pp.889-892
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• 2010

Botulinum toxin type A (BTX-A), a potent neurotoxin that reversibly blocks presynaptic acetylcholine release, has been applied successfully to treat facial spastic conditions such as blepharospasm, strabismus and cervical dystonia. Since the first reported application in dentistry in 1994, BTX-A has been used with great success to used in the orofacial region to help treat masticatory and facial muscle spasm, severe bruxism, facial tics, and hypertrophy of the masticatory muscles. The clinician may be aware of the many courses becoming available and aimed at dentists to start using it in the cosmetic context. This article intends to provide a basic understanding of the many functional uses of the drug in the orofacial region that may be relevant to everyday practice, especially in orthodontic field.

• Journal of TMJ Balancing Medicine
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• v.6 no.1
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• pp.24-26
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• 2016

To investigate the effects of the postural balance of TMJ using intraoral balancing appliance of functional cerebrospinal technique (FCST) combined acupuncture and manual medicine therapeutics in the treatment of congenital muscular torticollis. An idiopathic cervical dystonia case was managed with postural training with intraoral balancing appliance, combined with acupuncture and manual medicine therapeutics. Clinical assessment included radiography, Toronto Western Spasmodic Torticollis Rating Scale, and global clinical impression. Clinical improvement was observed over 5 months of treatment period. Clinical observational data on spasmodic torticollis provide an positive prospective for further investigation on the effect of FCST.