Botulinum Toxin Treatment in Patients with Spasmodic Torticollis

J Korean Neurol Assoc > Volume 15(4); 1997 > Article

Journal of the Korean Neurological Association 1997;15(4): 790-802.

연축성사경 환자에서 보툴리눔독소 주사 치료

이명식, 손영호, 김진수

연세대학교 영동세브란스 병원 신경과, 연세 뇌연구소

Botulinum Toxin Treatment in Patients with Spasmodic Torticollis

Myung Sik Lee, M.D., Young Ho Sohn, M.D., Jin Soo kim, M.D.

Department of Neurology, Yongdong Severance Hospital, Yonsei Brain Research Center, Yonsei University College of Medicine

Abstract

Spasmodic torticollis (ST) is a focal dystonia caused by a tonic or intermittent spasms of the neck muscles. Botulinum toxin type A has been known to be one of the effective treatments for the cervical dystonia. We report the result of low dose botulinum toxin type A injection in 26 patients with spasmodic torticollis. In addition to the careful neurological examination, a needle polymyographic analysis was used to identify muscles responsible for ST. The most common combination of the involved muscles was splenius capitus and sternocleidomastoid muscle. The mean dose of botulinum toxin used in the patient was 100 units (range ; 80-140 units). Mean dose of 25 units (range ; 20-30 units) for levator scapula, 30 units (range ; 20-40 units) for semispinalis, 37 units (range ; 25-50 units) for sternocleidomastoid, 40 units for trapezius and 58 units (range ; 40-100 units) for splenius capitus muscle were injected. Using Tsui score (for objective response rating scale) and the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS ; for objective and subjective response rating scale), we assessed the patient before and 2 , 6 and 10 weeks after the botulinum toxin injection. Seventeen of the 26 (65%) showed improvement on TWSTRS objective response rating scale, and 18 (69%) on Tsui scale. Comparing to the baseline score measured by Tsui scale, the amount of improvement was 37.1% (range 20-88%). Twenty one of the 26 (80.7%) reported improvement on subjective rating scale (TWSTRS). Twenty of the 21 responder on the subjective rating scale felt improvement within a week after the botulinum toxin injection. The beneficial effect lasted for 0.5 to longer than 9 months (mean ; 3.5months). We compared the result with that of the other studies in which larger doses of botulinum toxin were injected into the neck muscles selected on clinical ground. There was no significant difference of response rate and duration of beneficial effects. In our study, only two patients developed transient complications ; one