A clinical tool for real-time analysis and visualisation of cervical muscles for cervical dystonia (Manchester Metropolitan University) The Dystonia Society is currently funding a research project at Manchester Metropolitan University, where the team has been developing real time ultrasound. This software would help a clinician to identify the dystonic muscles in cervical dystonia requiring botulinum toxin (BoNT) injections. Knowledge of the pattern and extent of muscle involvement is essential in the assessment and treatment of people with cervical dystonia. Physical examination is limited in its ability to assess neck muscles, especially deep muscles. Better understanding of patterns of neck muscle structure and function in cervical dystonia will enhance diagnosis and treatment of this condition. The purpose of this project is to develop a clinical tool providing real-time analysis and visualisation of the three-dimensional (3-D) shape and texture of the neck muscles. The 3 proposal extends our recent demonstration of real-time 2-D analysis of the neck muscles. We will recruit 25 people with cervical dystonia and 25 healthy control participants. All participants will undergo MRI and ultrasound imaging of the neck muscles. We will use this information to build a model of normal neck muscle structure, and look for patterns associated with cervical dystonia compared to controls. The immediate benefit of the tool used in the clinic lies in the more accurate visualization of neck muscles and their involvement in cervical dystonia. The live imaging, diagnostic analysis and visualisation will assist informed communication between medical professionals and the person living with dystonia. This will also reduce the operator dependence of ultrasound for neck muscle analysis. In the future we plan to develop this tool to provide diagnostic information and details of abnormalities of neck muscle function in dystonia. This will be done by longitudinal studies of people with dystonia using this tool. We will study the effectiveness of the tool at enhancing delivery of treatments such as botulinum toxin. The longer term aim is to improve diagnostic tools, and provide treatment better targeted to the individual with dystonia.