Patent Application
20240108283
This invention pertains to method for treating cervical vertigo.
Cervical Vertigo (CV) or Cervical Dizziness may occur after trauma to the head and neck such as whiplash injury, after overuse or have insidious onset. The underlying condition of cervical dystonia may not be readily recognized without specialized electrodiagnostic testing.
Heretofore, a patient who has had a neck injury and is experiencing vertigo, but not diagnosed with cervical dystonia, is typically treated with physical therapy, vestibular therapy, acupuncture, massage, chiropractic manipulations, trigger point injections, medications, radiofrequency ablation, greater occipital nerve block, and surgery. Unfortunately, all of these treatments are associated with variable success.
What is needed is a method for quickly and effectively treating cervical vertigo caused by dystonia of selected neck muscles.
A method of quickly and effectively treating cervical vertigo by using EMG-guided injections of botulinum toxin into selective dystonic neck muscles. The term ‘EMG guided injections’ refers to the combination of an EMG needle assembly that includes a hollow needle with an electrode at its tip attached to a hub that attaches to a Luer Lock or Slip Tip hub on a syringe body. The hub is attached to a lead wire that connects to an EMG machine. The needle shaft has an insulated coating with an exposed tip. The tip of the needle functions as an electrode. The hub is attached to a 3 to 10 ml syringe body with volume indica that holds a measurable amount of botulinum toxin.
When EMG-guided injections are used, the tip of the EMG needle is inserted into the muscle. The EMG is then activated, and an EMG test is then performed to determine if the muscle is overactive. The amount of overactivity is closely observed. If the muscle is overactive, the amount of botulinum toxin administered from the needle depends on the amount (0 to 25 units) of overactivity detected.
Disclosed herein is a method for treating cervical vertigo developed after a neck injury. The neck injury induced dystonia in selective neck muscles, which led to cervical vertigo. The method uses an EMG needle with a syringe body filled with botulinum toxin.
The portable EMG machine (also called an amplifier) and EMG needle are sold by Natus Medical Incorporated, located at 3150 Pleasant View Road, Middleton, WI 533362. The syringe body may be a 3 to 10 ml syringe body with standard hub.
During a treatment, the EMG needle is inserted into one or more neck muscles believed to be associated with cervical vertigo. Each muscle is individually tested for overactive. If a muscle is overactive, then a sufficient amount of botulinum toxin is injected into the muscle to reduce overactivity. The amount of botulinum toxin may be limited by the manufacturer of the botulinum toxin.
A 54-year-old woman was hit by a wave in the back approximately ten years ago. She subsequently developed neck pain, vertigo spells, and muscle tension in the left trapezius. Vertigo sometimes occurred when she was lying in bed, with the first steps in the morning, and with full cervical rotation to the left. When the vertigo was severe, she felt nauseated and mostly had to lie down. She felt the dizziness was associated with tightness in the upper cervical muscles, including the oblique capitis superior and the inferior areas.
Testing for benign paroxysmal positional vertigo (BPPV) was negative, a course of prednisone and two cervical epidural steroid injections were given, all with short term benefits. A cervical MRI showed moderate to severe foraminal stenosis at R C3-4, and L C-6-7. Moderate foraminal stenosis at R C3-4, R C6-7, L C5-6 and L C7-T1. Mild foraminal stenosis at L C3-4.
An EMG assessment confirmed dystonia in the left trapezius, levator scapula, longissimus capitis, oblique capitis inferior, and oblique capitis superior.
A diagnosis of cervical dystonia was made based on her history, physical examination, head tilt to the left, limited cervical range of motion, and cervical dystonic muscular activity on EMG examination.
She was initially injected under EMG guidance with a total 100 units of incobotulinum toxin A (1:2 dilution in preservative-free saline) bilaterally to the oblique capitis superior muscles (OCS); (15 units+15 units) to the longissimus capitis muscle proximally; (15 units+15 units) and the trapezius (15 units) and the levator scapula distally (25 u).
The EMG needle was used to conduct an EMG test in the muscle and is also used to inject botulinum toxin into the muscle. The EMG needle is hollow with an insulating coating with an electrode mounted on the tip. During the procedure, the EMG needle was used on various muscles in the upper neck that control neck movement. While many neck muscles may be tested for dystonia, only muscles that are overactive via EMG testing are injected with botulinum toxin. In most cases, the overactive muscles are the oblique capitis superior muscle, the oblique capitis inferior, the longissimus capitis, the trapezius, and the levator scapula muscle.
Overactive muscle is believed to provide proprioceptive input to the brain that conflicts with visual and vestibular input. These conflicting inputs lead to vertigo.
The above-described patient experienced consistent resolution of her vertigo symptoms and pain after each treatment for a total of five treatments. During each treatment, all of the neck muscles were tested. Overactive muscles were administered botulinum toxin. The oblique capitis superior and the oblique capitis inferior were consistently injected bilaterally after each treatment.
An important finding for explaining the etiology of cervical vertigo is diagnosis of cervical dystonia, which was confirmed by EMG. It is postulated that cervical muscle overactivity and associated hyperactive muscle spindles provide an altered cervical somatosensory input. The mechanism is proprioceptive, and the sensory mismatch between cervical and vestibular input would be expected to result in cervical vertigo. In the present patient, chemodenervation with botulinum toxin of the dystonic neck muscles reduced muscle spasm and pain, and thus the proprioceptive input resulted in the improvement of her vertigo. Similar changes in proprioceptive input through physiotherapy, acupuncture, and manipulation have been shown to reduce neck pain and dizziness. Likewise, anesthetic muscle blocks to spastic cervical muscles reduce dizziness in patients with cervical spondylosis and in patients with neck pain. Another possible explanation for improving cervical vertigo is decompression of the occipital and sub-occipital nerves and blood vessels by chemodenervation of the overlying muscles. Such decompression would also promote normalization of the afferent input and improve cervical vertigo.
In compliance with the statute, the invention described has been described in language more or less specific as to structural features. It should be understood however, that the invention is not limited to the specific features shown, since the means and construction shown, comprises the preferred embodiments for putting the invention into effect. The invention is therefore claimed in its forms or modifications within the legitimate and valid scope of the amended claims, appropriately interpreted under the doctrine of equivalents.
This is a continuation in part application based on the utility patent application (application Ser. No. 17/157,787), filed on Jan. 25, 2021 which was based on and claimed the filing date benefit of U.S. Provisional Patent Application (Application No 62964923) filed on Jan. 23, 2020. Notice is given that the following patent document contains original material subject to copyright protection. The copyright owner has no objection to the facsimile or digital download reproduction of all or part of the patent document, but otherwise reserves all copyrights.
| Number | Date | Country | |
|---|---|---|---|
| 62964923 | Jan 2020 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 17157787 | Jan 2021 | US |
| Child | 18526717 | US |
