Abstract
Dystonia is a movement disorder characterized by persistent or intermittent muscle contractions, involuntary, creating repetitive and/or abnormal postures and movements. Dystonic movements result in characteristic twisting or tremor patterns. Dystonia often begins or worsens with intentional movements, combined with excessive muscle activation. Dystonia is classified according to the affected body regions: focal dystonia, segmental dystonia, multifocal dystonia, hemidystonia, and generalized dystonia. Anterocollis is a type of cervical dystonia, caused by persistent, repetitive contractions of neck muscle groups, leading to excessive neck flexion. Anterocollis is described in the context of movement disorders in Parkinson’s syndrome (Parkinson’s disease, multiple system atrophy, etc.). Treatment of dystonia is primarily symptomatic: medications, Botulinum Neurotoxin (BoNT) injections, surgery, and physical therapy. Among these, BoNT injections are considered the first choice for focal or segmental dystonia.
Botulinum Neurotoxin acts at the neuromuscular junction, leading to muscle paralysis. BoNT injections require injection equipment, surface disinfection, and determination of the injection site based on clinical landmarks. Some deep and difficult injections require specialized techniques such as electromyography (EMG) and ultrasound. In the case of anterocollis, BoNT is often applied to both superficial and deep muscles. To achieve effectiveness and limit complications during and after injection, practitioners often use combined EMG and ultrasound techniques. We present a clinical case to illustrate the value of using BoNT injections under the simultaneous guidance of EMG and ultrasound in treating anterocollis at the Neurology Department of Hanoi Medical University Hospital.