[Torticollis treated with botulinum toxin]

The effect of botulinum toxin A treatment was studied in patients with idiopathic torticollis. Twenty patients with idiopathic torticollis received electromyographically guided intramuscular botulinum toxin A into the hyperactive neck muscles. In all, 48 treatments were given. The injections were repeated with intervals of 11 to 35 weeks (mean 18.7 weeks). The grade of improvement was estimated subjectively using a visual analogue scale. An overall improvement of 55% compared with the status before treatment was found. The best result obtained in each individual patient varied from 20% to 84% (mean 66%). The effect of the treatment began to wear off after eight to 22 weeks (mean 11.5 weeks). The side effects consisted of short term dysphagia in two patients. The administration of botulinum toxin in idiopathic torticollis is a safe and beneficial treatment with few side effects. The EMG guidance of injections proved to be helpful as it restricted the injections into muscles with electromyographic hyperactivity, thereby economizing the amount of toxin given. It is doubtful if double-blind studies of botulinum toxin can be undertaken due to the marked muscular wasting and weakness caused by the injections.