Dystonia – Botulinum Toxin Treatment (Botox)

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Will Botulinum Toxin Injections (Botox) Help Me?

80 to 90 percent of patients with focal dystonia are significantly improved with Botox injections. Patients with cervical dystonia experience a reduction in neck pain, abnormal head positioning, neck stiffness, and tremor/jerking, and are better able to turn the head. Patients with eye twitching or involuntary eye closure (blepharospasm) are substantially improved in 80 to 90 percent of cases, resulting in improvement in the ability to read, drive, and carry out day-to-day activities.

Writer’s cramp and other forms of limb dystonia may interfere with only one specific task or with many different tasks requiring manual dexterity. Selective injections can improve the use of the hands for writing, playing an instrument, typing or other activities.

Treatable Symptoms

  • Cervical dystonia – Abnormal neck posturing, often with superimposed jerky movements, may cause pain and embarrassment, and interfere with work, driving and social activities.
  • Blepharospasm – Eye twitching and involuntary eye blinking can interfere with reading, driving and many other day-to-day activities. These symptoms are commonly worse when patients are outside in sunlight.
  • Limb dystonia – Abnormal hand posturing may be task specific, sometimes occurring only when the patient is writing (writer’s cramp) or performing some other fine dexterous activity, such as typing or playing a musical instrument. The abnormal hand posturing may make it difficult or impossible to accomplish these tasks.

Treatment Methods

Botulinum toxin is injected specifically into the overactive muscles causing the foot cramps or eye twitching, or into the salivary glands for drooling. The effect comes on gradually over several days, with the peak effect reached in approximately 2 weeks. The benefit lasts for about 3 months. As a result, injections are repeated at 3 month intervals to maintain ongoing benefits.

Prognosis When Untreated

Dystonia usually slowly worsens over 2 to 3 years, and thereafter continues as a chronic disability. Remission is uncommon, occurring in less than 5 percent of cases.

Prognosis With Treatment

Botulinum toxin (Botox) injections effectively treat cervical dystonia in between 80-90 percent of patients, resulting in improvement in pain, neck position and quality of life. The injections can occasionally cause mild trouble swallowing or excessive neck weakness, but such side effects are typically mild and short lived. Injections are customized for each individual patient with respect to the specific muscles and the specific doses used, to maximize the benefits and to reduce the chance of any adverse effects.

Oral medications are helpful in less than 25 percent of patients, and rarely result in the immediate improvement seen with botulinum toxin injections. In patients with severe and more widespread dystonia (generalized dystonia), deep brain stimulation may provide additional therapeutic benefit.

Blepharospasm is improved with botulinum toxin injections in 80 to 90 percent of patients. Drooping of the eyelids or dry eyes may occur as adverse effects. If these side effects occur, they are usually mild and go away within 2 or 3 weeks. The specific pattern and dose of the injection into the muscles responsible for eye closing is customized in order to maximize benefits and minimize adverse effects.

Task specific limb dystonia (e.g. writer’s cramp or musician’s cramp) can be improved with highly customized injections of small amounts of Botox to selectively weaken the overactive muscles, without causes excessive weakness or reducing dexterity. When done by a highly experienced physician, this improves function in more than 75 percent of patients. Very low doses are typically needed in order to prevent grip weakness or impairment of other tasks.

Botulinum toxin injections are the first line and most effective treatment for 80 to 90 percent of patients with dystonia.