Peter Misra

Poster 306 Clinical Characteristics of Cervical Dystonia: Differences between Patients Previously Treated with Botulinum Neurotoxin Type A and Naïve Patients

Twenty-one muscles were selected for injection at Visit 1; of these the 5 most commonly injected were splenius capitis (93% of patients), sternocleidomastoid (SCM) (91%), trapezius (63%), levator scapulae (42%), and the semispinalis capitis (27%). Other muscles were injected with a frequency between 0.4e6%. The mean total injected volumes were 1.05 1.16 mL for splenius capitis, 0.68 0.78 mL for SCM, 0.67 0.58 mL for trapezius, 0.42 0.26 mL for levator scapulae and 0.56 0.33 mL for semispinalis capitis. Mean number of injection points were: splenius capitis (2.7 1.5), SCM (2.2 1.2), trapezius (2.7 1.6), levator scapulae (1.5 0.7), and semispinalis capitis (2.0 1.3). At Visit 2 the frequency of muscles injected, the injected volume, and injection points were similar to Visit 1. Injection guidance techniques were used in 37% (SCM) to 57% (levator scapulae) of Visit 1 injections, and this did not change at Visit 2. Analyses by study center revealed that when an injector uses guidance for one muscle, they generally use it for all muscles. Conclusion: In these interim analyses, 5 muscles were identified as being most frequently injected for CD, with other muscles being injected at much lower rates. The muscles and injection method (volume and number of injection points) are in line with recommendations in the literature and did not change between visits.

Poster 305 Patterns of Cervical Dystonia of Patients Receiving BoNT-A Treatment

Twenty-one muscles were selected for injection at Visit 1; of these the 5 most commonly injected were splenius capitis (93% of patients), sternocleidomastoid (SCM) (91%), trapezius (63%), levator scapulae (42%), and the semispinalis capitis (27%). Other muscles were injected with a frequency between 0.4e6%. The mean total injected volumes were 1.05 1.16 mL for splenius capitis, 0.68 0.78 mL for SCM, 0.67 0.58 mL for trapezius, 0.42 0.26 mL for levator scapulae and 0.56 0.33 mL for semispinalis capitis. Mean number of injection points were: splenius capitis (2.7 1.5), SCM (2.2 1.2), trapezius (2.7 1.6), levator scapulae (1.5 0.7), and semispinalis capitis (2.0 1.3). At Visit 2 the frequency of muscles injected, the injected volume, and injection points were similar to Visit 1. Injection guidance techniques were used in 37% (SCM) to 57% (levator scapulae) of Visit 1 injections, and this did not change at Visit 2. Analyses by study center revealed that when an injector uses guidance for one muscle, they generally use it for all muscles. Conclusion: In these interim analyses, 5 muscles were identified as being most frequently injected for CD, with other muscles being injected at much lower rates. The muscles and injection method (volume and number of injection points) are in line with recommendations in the literature and did not change between visits.

Poster 304 Evolution of Injection Technique with Repeat Botulinum Therapy in Patients with Cervical Dystonia

Results or Clinical Course: During all types of simulated rehabilitation exercises following both partial and complete LCL injury, vertical overhead positioning enhanced elbow stability as compared to other arm positions (P<.05). However, during elbow extension in the vertical overhead position following complete LCL injury, simulated active motion did not significantly improve stability as compared to passive motion (P 1⁄4 .071). Conclusion: There is a biomechanical basis for doing exercises in the vertical overhead position following LCL injury. Previous studies show that muscle activation improves elbow stability when the arm is dependently positioned. This investigation found, however, that the impact of active versus passive motion may be less significant when exercises are done with the arm overhead. Initiating earlier range of motion in the “safer” overhead position may prevent the development of elbow flexion contracture, a common occurrence post-ligamentous injury. Cadaveric studies can be used to elicit optimal rehabilitation strategies without causing patient discomfort.

Poster 303 Correlation between Tsui Tremor Scores and the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) in Clinical Practice

Results or Clinical Course: During all types of simulated rehabilitation exercises following both partial and complete LCL injury, vertical overhead positioning enhanced elbow stability as compared to other arm positions (P<.05). However, during elbow extension in the vertical overhead position following complete LCL injury, simulated active motion did not significantly improve stability as compared to passive motion (P 1⁄4 .071). Conclusion: There is a biomechanical basis for doing exercises in the vertical overhead position following LCL injury. Previous studies show that muscle activation improves elbow stability when the arm is dependently positioned. This investigation found, however, that the impact of active versus passive motion may be less significant when exercises are done with the arm overhead. Initiating earlier range of motion in the “safer” overhead position may prevent the development of elbow flexion contracture, a common occurrence post-ligamentous injury. Cadaveric studies can be used to elicit optimal rehabilitation strategies without causing patient discomfort.

Poster 179 Evolution of Cervical Dystonia and Patient Satisfaction with Repeat Botulinum Toxin Therapy in Clinical Practice

Participants: A total of 721 medical records were reviewed in Seoul National University Hospital Healthcare System Gangnam Center and data of 165 older subjects (> 65 years, 81 men and 84 women) were retrospectively analyzed. Main Outcome Measures: Subjects were categorized into either CLBP (back pain for 6 months; 35 men and 36 women) or control groups (46 men and 48 women). The Modified Skeletal Muscle Mass Index (MSMI), lumbar lordotic angles (LLA), and prevalence of sarcopenia were evaluated. Results or Clinical Course: The LLA of men and women in the CLBP group (29.8 10.6 degrees, 32.1 11.2 degrees, respectively) were significantly lower (P 1⁄4 .001 and .006, respectively) than those the control group (37.1 8.5 degrees and 38.3 9.2 degrees, respectively). Additionally, MSMI was decreased in the CLBP group compared to the control group; it was 31.2 1.7% vs. 32.3 1.9% (P 1⁄4 .008) in men, 26.1 1.9% vs. 27.1 2.1% (P 1⁄4 .02) in women. For both sexes, positive correlations were also observed between MSMI and LLA (r 1⁄4 0.220, P 1⁄4 .048 in men, r 1⁄4 0.225, P 1⁄4.040 in women). Conclusion: A close cross-sectional relationship was observed between sarcopenia and CLBP suggesting potential interactions between decreased muscle mass, altered lumbar spine sagittal alignment, and CLBP.