Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1990 Aug;53(8):633–639. doi: 10.1136/jnnp.53.8.633

Botulinum toxin treatment of cranial-cervical dystonia, spasmodic dysphonia, other focal dystonias and hemifacial spasm.

J Jankovic 1, K Schwartz 1, D T Donovan 1
PMCID: PMC488162  PMID: 2213039

Abstract

In the past five years, 477 patients with various focal dystonias and hemifacial spasm received 3,806 injections of botulinum A toxin for relief of involuntary spasms. A definite improvement with a global rating greater than or equal to 2 on a 0-4 scale, was obtained in all 13 patients with spasmodic dysphonia, 94% of 70 patients with blepharospasm, 92% of 13 patients with hemifacial spasm, 90% of 195 patients with cervical dystonia, 77% of 22 patients with hand dystonia, 73% of 45 patients with oromandibular dystonia, and in 90% of 21 patients with other focal dystonia who had adequate follow up. While the average duration of maximum improvement lasted about 11 weeks after an injection (range seven weeks in patients with hand dystonia to 15 weeks in patients with hemifacial spasm), some patients benefited for over a year. Only 16% of the 941 treatment visits with follow up were not successful. Except for transient focal weakness, there were very few complications or systemic effects attributed to the injections. This study supports the conclusion that botulinum toxin injections are a safe and effective therapy for patients with focal dystonia and hemifacial spasm.

Full text

PDF

Images in this article

635Image
on p.635

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Biglan A. W., Gonnering R., Lockhart L. B., Rabin B., Fuerste F. H. Absence of antibody production in patients treated with botulinum A toxin. Am J Ophthalmol. 1986 Feb 15;101(2):232–235. doi: 10.1016/0002-9394(86)90601-x. [DOI] [PubMed] [Google Scholar]
  2. Black J. D., Dolly J. O. 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. doi: 10.1083/jcb.103.2.521. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Brin M. F., Blitzer A., Fahn S., Gould W., Lovelace R. E. Adductor laryngeal dystonia (spastic dysphonia): treatment with local injections of botulinum toxin (Botox). Mov Disord. 1989;4(4):287–296. doi: 10.1002/mds.870040401. [DOI] [PubMed] [Google Scholar]
  4. Brin M. F., Fahn S., Moskowitz C., Friedman A., Shale H. M., Greene P. E., Blitzer A., List T., Lange D., Lovelace R. E. Localized injections of botulinum toxin for the treatment of focal dystonia and hemifacial spasm. Mov Disord. 1987;2(4):237–254. doi: 10.1002/mds.870020402. [DOI] [PubMed] [Google Scholar]
  5. Cohen L. G., Hallett M., Geller B. D., Hochberg F. Treatment of focal dystonias of the hand with botulinum toxin injections. J Neurol Neurosurg Psychiatry. 1989 Mar;52(3):355–363. doi: 10.1136/jnnp.52.3.355. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dolly J. O., Black J., Williams R. S., Melling J. Acceptors for botulinum neurotoxin reside on motor nerve terminals and mediate its internalization. Nature. 1984 Feb 2;307(5950):457–460. doi: 10.1038/307457a0. [DOI] [PubMed] [Google Scholar]
  7. Jankovic J. Etiology and differential diagnosis of blepharospasm and oromandibular dystonia. Adv Neurol. 1988;49:103–116. [PubMed] [Google Scholar]
  8. Jankovic J., Ford J. Blepharospasm and orofacial-cervical dystonia: clinical and pharmacological findings in 100 patients. Ann Neurol. 1983 Apr;13(4):402–411. doi: 10.1002/ana.410130406. [DOI] [PubMed] [Google Scholar]
  9. Jankovic J., Orman J. Botulinum A toxin for cranial-cervical dystonia: a double-blind, placebo-controlled study. Neurology. 1987 Apr;37(4):616–623. doi: 10.1212/wnl.37.4.616. [DOI] [PubMed] [Google Scholar]
  10. Jankovic J., Schwartz K. Botulinum toxin injections for cervical dystonia. Neurology. 1990 Feb;40(2):277–280. doi: 10.1212/wnl.40.2.277. [DOI] [PubMed] [Google Scholar]
  11. Katz B., Rosenberg J. H. Botulinum therapy for apraxia of eyelid opening. Am J Ophthalmol. 1987 May 15;103(5):718–719. doi: 10.1016/s0002-9394(14)74342-9. [DOI] [PubMed] [Google Scholar]
  12. Lange D. J., Brin M. F., Warner C. L., Fahn S., Lovelace R. E. Distant effects of local injection of botulinum toxin. Muscle Nerve. 1987 Jul-Aug;10(6):552–555. doi: 10.1002/mus.880100610. [DOI] [PubMed] [Google Scholar]
  13. Ludlow C. L., Naunton R. F., Sedory S. E., Schulz G. M., Hallett M. Effects of botulinum toxin injections on speech in adductor spasmodic dysphonia. Neurology. 1988 Aug;38(8):1220–1225. doi: 10.1212/wnl.38.8.1220. [DOI] [PubMed] [Google Scholar]
  14. Miller R. H., Woodson G. E., Jankovic J. Botulinum toxin injection of the vocal fold for spasmodic dysphonia. A preliminary report. Arch Otolaryngol Head Neck Surg. 1987 Jun;113(6):603–605. doi: 10.1001/archotol.1987.01860060029009. [DOI] [PubMed] [Google Scholar]
  15. Rosenbaum F., Jankovic J. Focal task-specific tremor and dystonia: categorization of occupational movement disorders. Neurology. 1988 Apr;38(4):522–527. doi: 10.1212/wnl.38.4.522. [DOI] [PubMed] [Google Scholar]
  16. Sanders D. B., Massey E. W., Buckley E. G. Botulinum toxin for blepharospasm: single-fiber EMG studies. Neurology. 1986 Apr;36(4):545–547. doi: 10.1212/wnl.36.4.545. [DOI] [PubMed] [Google Scholar]
  17. Scott A. B. Botulinum toxin injection of eye muscles to correct strabismus. Trans Am Ophthalmol Soc. 1981;79:734–770. [PMC free article] [PubMed] [Google Scholar]
  18. Scott A. B., Kennedy R. A., Stubbs H. A. Botulinum A toxin injection as a treatment for blepharospasm. Arch Ophthalmol. 1985 Mar;103(3):347–350. doi: 10.1001/archopht.1985.01050030043017. [DOI] [PubMed] [Google Scholar]
  19. Sellin L. C. The action of batulinum toxin at the neuromuscular junction. Med Biol. 1981 Feb;59(1):11–20. [PubMed] [Google Scholar]
  20. Stell R., Thompson P. D., Marsden C. D. Botulinum toxin in spasmodic torticollis. J Neurol Neurosurg Psychiatry. 1988 Jul;51(7):920–923. doi: 10.1136/jnnp.51.7.920. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Tolosa E., Martí M. J., Kulisevsky J. Botulinum toxin injection therapy for hemifacial spasm. Adv Neurol. 1988;49:479–491. [PubMed] [Google Scholar]
  22. Wiegand H., Erdmann G., Wellhöner H. H. 125I-labelled botulinum A neurotoxin: pharmacokinetics in cats after intramuscular injection. Naunyn Schmiedebergs Arch Pharmacol. 1976;292(2):161–165. doi: 10.1007/BF00498587. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES