Botulinum toxin as an effective treatment for persistent twitching in first toe: a detailed case study

Area of Science:

• Neurology
• Clinical Case Study

Background:

• Benign fasciculation, characterized by continuous muscle twitching without weakness, can significantly impair quality of life.
• Intractable cases pose treatment challenges, often unresponsive to conventional therapies.

Purpose of the Study:

• To report a case of persistent, localized benign fasciculation unresponsive to standard treatments.
• To evaluate the efficacy of botulinum toxin injections in managing intractable foot twitching.

Main Methods:

• A case study of a male patient in his 30s with a 2-year history of left foot sole twitching.
• Diagnostic workup included normal electromyography and failed pharmacological interventions.
• Ultrasound-guided botulinum toxin injections into the flexor hallucis and digitorum longus muscles were administered.

Main Results:

• Botulinum toxin injections led to a significant reduction in both the frequency and severity of fasciculations.
• The patient experienced improved daily functioning and sleep quality without adverse effects.
• Nerve block provided temporary symptom relief but was not a lasting solution.

Conclusions:

• Botulinum toxin injections represent a promising therapeutic option for intractable benign fasciculations.
• Ultrasound-guided injection technique ensures targeted delivery and enhances treatment efficacy.
• This case highlights a potential strategy for managing debilitating muscle twitching unresponsive to other treatments.