[Injection of botulinum toxin as a new treatment of torticollis]

Thirty patients with spasmodic torticollis were injected with Botulinum A toxin into sternomastoid and posterior neck muscles. Neurophysiological investigation showed neuromuscular transmission in the sternomastoid muscle to be impaired already within the first day after injection of 50 U toxin. Signs of denervation were discernible after seven days, and of reinnervation after two weeks. As assessed by 'blind' ratings of videotapes, 78 per cent of the patients improved, as compared with the figure of 87 per cent based on clinical evaluation. When injections were repeated every third month, there was a tendency for symptomatic effects to increase with time. Side effects were mild and transient. Thus local injections of botulinum toxin would seem to be the treatment of choice in this form of dystonia.