Objective: To communicate the advantages of botulinum toxin application for dystonia under tomographic guidance in cervical muscles applying the Col/Cap concept.
Background: The first case involves a 23-year-old patient with a psychiatric condition and a history of receiving risperidone. He presents with a two-year history of complex cervical dystonia, with left torticollis combined with laterocollis and torticaput. After a standard application of 300 units of “Botulax” in the sternocleidomastoid, trapezius, and splenius muscles, there was a 20% improvement in the TWSTRS dystonia scale. The second case involves a 38-year-old patient with complex cervical dystonia (torticollis + retrocollis + torticaput) of 5 years’ duration. Genetic testing revealed a mutation in the TAF-1 gene. Repeated botulinum toxin applications in the splenius, semispinalis capitis, sternocleidomastoid, and trapezius muscles, combined with the placement of a Deep Brain Stimulation device, produced a 48% improvement.
Method: The cases were analyzed according to the Col/Cap concept, which allowed identification of the inferior oblique capitis muscle as involved in the ipsilateral torticollis/laterocaput component in both cases. 150 units of “Dysport” were applied to this muscle under tomographic guidance (Siemens brand, 64 slices), with local anesthesia (2% lidocaine) using a Spinocath.
Results: The inclusion of the inferior oblique capitis muscle in the botulinum toxin application protocol resulted in an 83% improvement in the first case and a 17% improvement in the second case.
Conclusion: The analysis of cervical dystonia cases using the Col/Cap concept and the subsequent application of botulinum toxin to frequently involved deep muscles using tomographic guidance results in a significant improvement in treatment outcomes.
To cite this abstract in AMA style:
I. Amorín, A. Rodriguez, N. Sorondo, B. Cardozo. Use of Botulinum Toxin Application in the Inferior Oblique Capitis Muscle Under Tomographic Guidance in Cervical Dystonia Report of Two Cases [abstract]. Mov Disord. 2025; 40 (suppl 1). https://www.mdsabstracts.org/abstract/use-of-botulinum-toxin-application-in-the-inferior-oblique-capitis-muscle-under-tomographic-guidance-in-cervical-dystonia-report-of-two-cases/. Accessed November 20, 2025.« Back to 2025 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/use-of-botulinum-toxin-application-in-the-inferior-oblique-capitis-muscle-under-tomographic-guidance-in-cervical-dystonia-report-of-two-cases/