PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of jrsocmedLink to Publisher's site
 
J R Soc Med. 1992 September; 85(9): 524–529.
PMCID: PMC1293637

Botulinum toxin treatment of spasmodic torticollis.

Abstract

We reviewed the efficacy and adverse effects of repeated botulinum toxin injections into hyperactive neck muscles of 107 successive patients with spasmodic torticollis. They received 510 injection treatments over a median period of 15 months (range 3-42 months). One patient failed to benefit at all, but 101 (95%) patients reported considerable (moderate or excellent) benefit from at least one treatment. On a global subjective response rating, 93% of 429 treatments resulted in some improvement and 76% in moderate or excellent improvement. Pain reduction followed 89% of 190 treatments with moderate or excellent reduction after 66%. Median duration of benefit was 9 weeks. All torticollis types responded equally well and injections into two (or more) involved neck muscles were more effective than injection into a single muscle. The most frequent adverse effect was dysphagia, occurring after 44% of all treatments, but this was severe after only 2%. Antibodies to botulinum toxin were detected in the serum of three out of the five patients in whom loss of treatment efficacy occurred. We conclude that botulinum toxin treatment is the most effective available therapy for spasmodic torticollis and practical advice is provided for anyone wishing to set up the technique.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.4M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Images in this article

Click on the image to see a larger version.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Greene P, Shale H, Fahn S. Analysis of open-label trials in torsion dystonia using high dosages of anticholinergics and other drugs. Mov Disord. 1988;3(1):46–60. [PubMed]
  • Dolly JO, Lande S, Wray DW. The effects of in vitro application of purified botulinum neurotoxin at mouse motor nerve terminals. J Physiol. 1987 May;386:475–484. [PubMed]
  • Tsui JK, Eisen A, Stoessl AJ, Calne S, Calne DB. Double-blind study of botulinum toxin in spasmodic torticollis. Lancet. 1986 Aug 2;2(8501):245–247. [PubMed]
  • de Mendonça A, Pimentel J, Morgado F, Ferro JM. Mesencephalic haematoma: case report with autopsy study. J Neurol. 1990 Feb;237(1):55–58. [PubMed]
  • Greene P, Kang U, Fahn S, Brin M, Moskowitz C, Flaster E. Double-blind, placebo-controlled trial of botulinum toxin injections for the treatment of spasmodic torticollis. Neurology. 1990 Aug;40(8):1213–1218. [PubMed]
  • Brin MF, Fahn S, Moskowitz C, Friedman A, Shale HM, Greene PE, Blitzer A, List T, Lange D, Lovelace RE, et al. Localized injections of botulinum toxin for the treatment of focal dystonia and hemifacial spasm. Mov Disord. 1987;2(4):237–254. [PubMed]
  • Stell R, Thompson PD, Marsden CD. Botulinum toxin in spasmodic torticollis. J Neurol Neurosurg Psychiatry. 1988 Jul;51(7):920–923. [PMC free article] [PubMed]
  • Jankovic J, Schwartz K. Botulinum toxin injections for cervical dystonia. Neurology. 1990 Feb;40(2):277–280. [PubMed]
  • Stell R, Thompson PD, Marsden CD. Botulinum toxin in torticollis. Neurology. 1989 Oct;39(10):1403–1404. [PubMed]
  • Gelb DJ, Lowenstein DH, Aminoff MJ. Controlled trial of botulinum toxin injections in the treatment of spasmodic torticollis. Neurology. 1989 Jan;39(1):80–84. [PubMed]
  • Critchley EM, Hayes PJ, Isaacs PE. Outbreak of botulism in north west England and Wales, June, 1989. Lancet. 1989 Oct 7;2(8667):849–853. [PubMed]
  • Black JD, Dolly JO. Interaction of 125I-labeled botulinum neurotoxins with nerve terminals. I. Ultrastructural autoradiographic localization and quantitation of distinct membrane acceptors for types A and B on motor nerves. J Cell Biol. 1986 Aug;103(2):521–534. [PMC free article] [PubMed]
  • Wiegand H, Erdmann G, Wellhöner HH. 125I-labelled botulinum A neurotoxin: pharmacokinetics in cats after intramuscular injection. Naunyn Schmiedebergs Arch Pharmacol. 1976;292(2):161–165. [PubMed]
  • Olney RK, Aminoff MJ, Gelb DJ, Lowenstein DH. Neuromuscular effects distant from the site of botulinum neurotoxin injection. Neurology. 1988 Nov;38(11):1780–1783. [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press