We assessed 26 patients with cervical dystonia, in whom botulinum toxin (BT) injections had failed, before selective peripheral denervation. We decided to base the decision which muscle should be denervated on both clinical information and EMG data and focussed on the following features: activity at onset or during ‘dystonic spasms’ (according to the concept of the ‘leading’ dystonic muscle), paradoxical activity during voluntary head movements causing restriction of head movements opposite the side of head turn or tilt and activity when symptoms deteriorated during walking. To identify these muscles we developed a new recording system that integrates simultaneous video-taping and polymyography (video EMG) by means of a digital counter, driven by the recording software (resolution 0.1 s), that was fixed in view of the video camera. This system time-locked clinical signs with relevant EMG activity thus allowing demonstration of the above features. These were found in 68% of dystonic muscles with each of them being present in approximately 40%. Video EMG allows an integrated approach to identify overactive neck muscles in patients with cervical dystonia taking into account both relevant clinical findings and EMG data.

Jankovic J, Leder S, Warner D, Schwartz KS: Cervical dystonia: Clinical findings and associated movement disorders. Neurology 1991;41:1088–1091.
Chan J, Brin MF, Fahn S: Idiopathic cervical dystonia: Clinical characteristics. Mov Disord 1991;6:119–126.
Tsui JKC, Eisen A, Stoessl AJ, Calne S, Calne DB: Double-blind study of botulinum toxin in spasmodic torticollis. Lancet 1986;ii:245–247.
Anderson TJ, Rivest J, Stell R, Steiger MJ, Cohen H, Thompson PD, Marsden CD: Botulinum toxin treatment of spasmodic torticollis. J R Soc Med 1992;85:524–529.
Kessler KR, Skutta M, Benecke R: Long-term treatment of cervical dystonia with botulinum toxin A: Efficacy, safety, and antibody frequency. German Dystonia Study Group. J Neurol 1999;246:265–274.
Jankovic J, Schwartz K: Response and immunoresistance to botulinum toxin injections. Neurology 1995;45:1743–1746.
Bertrand CM: Selective peripheral denervation for spasmodic torticollis: Surgical technique, results, and observations in 260 cases. Surg Neurol 1993;40:96–103.
Braun V, Richter HP: Selective peripheral denervation for the treatment of spasmodic torticollis. Neurosurgery 1994;35:58–63.
Krauss JK, Toups EG, Jankovic J, Grossman RG: Symptomatic and functional outcome of surgical treatment of cervical dystonia. J Neurol Neurosurg Psychiatry 1997;63:642–648.
Ford B, Louis ED, Greene P, Fahn S: Outcome of selective ramisectomy for botulinum toxin resistant torticollis. J Neurol Neurosurg Psychiatry 1998;65:472–478.
Münchau A, Palmer JP, Dressler D, O’Sullivan JD, Tsang KL, Jahanshahi M, Quinn NP, Lees A, Bhatia KP: Prospective study of selective peripheral denervation for botulinum-toxin resistant patients with cervical dystonia. Brain 2001, in press.
Yanagisawa N, Goto A: Dystonia musculorum deformans: Analysis with electromyography. J Neurol Sci 1971;13:39–65.
Deuschl G, Heinen F, Kleedorfer B, Wagner M, Lücking CH, Poewe W: Clinical and polymyographic investigation of spasmoid torticollis. J Neurol 1992;239:9–15.
Podivinsky F: Torticollis; in Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology. Amsterdam, North-Holland, 1969, vol 6, pp 567–603.
Tijssen MAJ, Marsden JF, Brown P: Frequency analysis of EMG activity in patients with idiopathic torticollis. Brain 2000;123:677–686.
Kaňovský, Dufek J, Halačková H, Rektor I: Change in pattern of cervical dystonia might be the cause of benefit loss during botulinum toxin treatment. Eur J Neurol 1997;4:79–84.
Chawda SJ, Münchau A, Johnson D, Bhatia K, Quinn NP, Stevens J, Palmer JD: The pattern of premature degenerative changes of the cervical spine in patients with spasmodic torticollis and the impact on the outcome of selective peripheral denervation. J Neurol Neurosurg Psychiatry 2000;68:465–471.
Consky ES, Lang AE: Clinical assessments of patients with cervical dystonia; in Jankovic J, Hallet M (eds): Therapy with Botulinum Toxin. New York, Dekker, 1994, pp 211–237.
Thompson PD, Stell R, Maccabe JJ, Day BL, Rothwell JC, Marsden CD: Electromyography of neck muscles and treatment in spasmodic torticollis; in Berardelli A, Benecke R, Manfredi M, Marsden CD (eds): Motor Disturbances. II. London, Academic Press, 1990, pp 289–304.
Matthews WB, Beasley P, Parry-Jones W, Garland G: Spasmodic torticollis: A combined clinical study. J Neurol Neurosurgy Psychiatry 1978;41:485–492.
Fasshauer K: Klinische and elektromyographische Verlaufsuntersuchungen beim Torticollis spasmodicus. Nervenarzt 1983;54:535–539.
Herz E, Hoefer PFA: Spasmodic torticollis. I. Physiologic analysis of involuntary motor activity. Arch Neurol Psychiatry 1949;61:129–136.
Wissel J, Poewe W: Electromyography for identification of dystonic muscles; in Moore P (ed): Handbook of Botulinum Toxin Treatment. London, Blackwell, 1995, pp 54–67.
Lücking CH: Phasische and tonische Bewegungsstörung des Torticollis und der Torsionsdystonie; in Mertens HG, Przuntek H (eds): Verhandlung der Deutschen Gesellschaft für Neurologie. Berlin, Springer, 1980, vol 1, pp 144–155.
Marin C, Martí MJ, Tolosa E, Alvarez R, Montserrat L, Santamaria J: Muscle activity changes in spasmodic torticollis after botulinum toxin treatment. Eur J Neurol 1995;1:24–247.
Tsui JKC, Eisen A, Calne DB: Botulinum toxin in spasmodic torticollis. Adv Neurol 1988;50:593–597.
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