Dystonia2018-12-10T19:30:36+00:00

Cervical Dystonia

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About Cervical Dystonia

Cervical dystonia is a form of abnormal movement characterized by abnormal head and neck position caused by involuntary contraction of neck muscles. This may result in sustained abnormal position or jerky repetitive movements mimicking tremor.
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Cervical dystonia is a form of abnormal movement characterized by abnormal head and neck position caused by involuntary contraction of neck muscles. This may result in sustained abnormal position or jerky repetitive movements mimicking tremor.

Cervical dystonia more commonly effects women than men and usually begins in middle age, typically between the ages of 30 and 60 though it may begin in younger individuals or in the elderly. The head tends to presume a dominant position with either turning, tilting, or shifting of the neck to one side or the other. The movements are a result in sustained abnormal posturing, jerky tremulous-­‐like movements or a combination of both sustained posture plus jerky movements.

A variety of different abnormal head postures may be seen. Torticollis refers to turning of the head to the right or left. Laterocollis means tilting of the head to the right or left.  Retrocollis refers to pulling of the head backward, and anterocollis tilting of the head forward. In addition, the head may shift laterally or to the sides toward one shoulder or the other or may shift forward -­‐ like a duck may move their head forward or backward.  Forward and backward shift of the neck is referred to as sagiMal shift.

The abnormal contractions of the neck may also involve the shoulder resulting in shoulder elevation or forward deviation.  Jerky tremulous-­‐like movements often occur and the majority of patients have associated neck and shoulder pain. Pain in some patients may be even more disabling than the abnormal movements. Symptoms of cervical dystonia gradually come on over one to two years and then tend to stabilize. Remission is seen in only a small percentage of patients, and even in those in whom remission occurs, the symptoms typically come back.  Cervical dystonia can occur by itself and is then considered a focal cervical dystonia or can be part of more widespread dystonia.  When cervical dystonia is combined with dystonia involving the face, it is referred to as craniocervical segmental dystonia. Cervical dystonia may also occur as part of widespread dystonia involving several limbs and the trunk, in which case it is part of generalized dystonia.

When cervical dystonia remains focal and does not involve other areas of the body, it is generally idiopathic; meaning we do not know the underlying cause. It is thought that in most of these cases, there is an underlying genetic cause, but we have not yet identified the gene. Recently, three different genes have been identified that may cause familial isolated cervical dystonia, but it is thought that these genes account for only a very small percentage of patients who have focal cervical dystonia. Cervical dystonia may also occur due to acquired causes such as exposure to dopamine-­‐ blocking drugs or rarely due to head or neck trauma. There is some controversy as to whether or not posttraumatic cervical dystonia is the same disorder as cervical dystonia, which comes on unassociated with trauma.

The majority of patients with cervical dystonia are initially misdiagnosed as having a stiff neck or arthritis involving the neck. When jerky or tremulous movements are present resulting in dystonic head tremor, patients are often misdiagnosed as having essential head tremor. Given the fact that no specific tests are available to make the diagnosis and the diagnosis based on careful history and examination, it is important to see a neurologist or other physician who specializes in movement disorders to be certain of having an accurate diagnosis.

Unfortunately, no cure is available for focal cervical dystonia and all of our treatments are aimed at reducing symptoms and improving quality of life. Specifically, the available treatments may improve the abnormal head positioning and jerky movements, reduce pain, and help to reduce development of secondary complications such as accelerated neck arthritis. There are three main forms of treatment:  Botulinum toxin injections are the standard first-­‐line treatment.  Oral medications may be used typically in patients who do not have an adequate response to botulinum toxin injections alone. Focal surgery to cut different nerves and muscles or deep brain stimulation may be used in patients with severe dystonia who do not have an adequate response to more conservative treatments.

Treating Cervical Dystonia

Treatment is aimed at reducing symptoms and as a result improving quality of life. The first goal is usually to improve the abnormal head position and jerky movements of the head and neck. Since pain occurs in the majority of patients with cervical dystonia and reduction of these abnormal movements and reduction of muscle spasm can easily substantially improve pain.  Secondary complications may occur as a result of the abnormal head posturing and jerking movements. Contractures may occur, which means that there can be limitation in range of motion of the neck due to permanent shortening of the muscles in the neck.  Accelerated arthritis may occur, resulting in compression of the nerve roots which exit the neck resulting in pain and weakness in the neck and arms this is referred to as a cervical radiculopathy. Accelerated arthritis may also result in compression of the spinal cord, resulting in weakness and numbness in the arms and the legs as well as difficulties controlling the bladder and bowel this is referred to as cervical myelopathy. Therefore, another important goal of treatment is to reduce the risk of developing the secondary complications.

Botulinum toxin injections are the treatment of choice for patients with cervical dystonia.  The toxin is injected into the overactive muscles to the overactive muscles to result in selective weakening of the muscles just along the normally active muscles to bring the head to a more normal position.  The effect comes on gradually over several days with peak effect in approximately two weeks. The benefit lasts on average for about 12 weeks.

When the botulinum toxin is injected into the overactive muscle, it is taken up by the nerve ending which supplies the signal to the muscle to contract. Once inside the nerve ending, the toxin breaks down a protein which is necessary for the release of acetylcholine by the nerve ending. Acetylcholine acts as a signal from the nerve ending to the muscle to contract. The end result is that the toxin prevents the communication from the nerve ending to the overactive muscle resulting in temporary weakening of the overactive muscle reducing involuntary movement and muscle spasm. The effect is not permanent and the nerve ending eventually regenerates the protein which has been broken down by the botulinum toxin in the nerve ending that prevents release of the acetylcholine signal from the nerve ending to the muscle. When this important signaling protein is regenerated, the nerve ending can communicate with the muscle and the improvement of symptoms goes away.

There are two major forms of botulinum toxin, Type A and Type B. Type A botulinum toxins are used more commonly and the name brands are Botox, Dysport, and Xeomin. The name brand of Type B botulinum injection is Myobloc.  Type A and Type  B toxins work similarly, except that the type A toxins break down a different protein in nerve endings than does Type B toxin. The different forms of botulinum toxin have similar benefits and adverse effects. The effect of botulinum toxin injection is temporary and as a result patients need periodic injections.  A very small percentage of patients, perhaps 1 or 2%, may develop antibodies to one type of botulinum toxin so that injections are no longer effective.  If this occurs, patients may be switched from one type of toxin to another type of toxin.

The selection of the muscles and the dose that each muscle receives when botulinum toxin injections are performed must be customized based on the pattern and severity of abnormal movements as well as the size of the involved muscles, and the patient’s response to previous sets of injections.  Patients need to undergo careful examination of what muscles to inject and the specific doses should be determined.

Injections are distributed amongst the various muscles, customized and based on the patient’s pattern of abnormal movements. EMG guidance is often used to help localize the overactive muscles.  EMG stands for electromyography and is a neurophysiologic method by which the electrical activity of muscle activity can be recorded.

After injections are performed, the onset of effect occurring gradually over a few days with a peak effect in approximately two to four weeks. The average duration of improvement of symptoms is 12 weeks, though there is substantial variability from patient-­‐to-­‐patient.  About 80% of patients experience significant improvement in abnormal neck posturing and pain.

The main effect of the botulinum toxin injection is to produce selective muscle weakness.  Excessive weakness may occur, resulting in a floppiness of the head and more difficulty bringing the head up to neutral when the head is flexed or bringing the head forward when the head is extended such as when liYing the head off the pillow when in bed. Dry mouth can occur due to spread of the toxin to the salivary glands.  Occasional patients may experience transient flu-­‐like symptoms.  Pain may occur at the injection site due to the mechanical effect of placing a needle in different muscles.  Injection site pain typically lasts only one or two days and is usually improved with taking simple pain relievers such as Tylenol or ibuprofen. Excessive muscle weakness and dry mouth typically also improves over a few weeks.

Treating Cervical Dystonia with Surgery and Oral Medications

Surgery is reserved for patients with severe dystonia with significant impairment in quality of life. Usually, this means that patients have an inadequate response to aggressive treatment with botulinum toxin injections and oral medications. Surgery may also be used in patients who initially responded well, but who have subsequently developed resistance to both botulinum toxin Type A and Type B. Most commonly, surgery is especially helpful in patients who have marked anterocollis (neck flexion) or retrocollis (neck extension). Since it may be difficult to improve patients with severe anterocollis adequately without causing substantial trouble swallowing. It may be difficult to adequately improve patients with severe retrocollis since this may result in excessive weakness of the neck extensor muscles. Cervical dystonia may also occur as part of more widespread segmental and generalized dystonia in which case botulinum toxin injections may not be able to be applied throughout the entire areas affected.

Local surgery which involves cueng specific overactive nerves and muscles causing the abnormal movements is referred to as selective denervation.  This surgery is usually applied in patients who have predominantly abnormal neck turning, also known as torticollis, or neck tilting, also called laterocollis.  It is usually used in patients who initially had a good response to botulinum toxin injections but subsequently developed resistance. Since the efficacy of this surgery is similar to that seen with botulinum toxin injections.  It is usually not very effective for patients with predominantly retrocollis, where the head is pulling back, or anterocollis where the head is pulling forward.  Since nerves and muscles are cut, the effect is permanent.

Typical complications include tingling and burning in the areas of the skin where the nerves have been cut, trouble swallowing, or excessive weakness of the neck. Many of these adverse effects gradually resolve aYer surgery over a period of weeks or months.

Deep brain stimulation refers to I am planning electrodes in specific areas of the brain and hooking up the electrode to a pacemaker-­‐like device, which is usually implanted just below the collar bone. The idea behind this surgery is to jam the abnormal brain signals responsible for generating the dystonia. The electrodes are usually placed in the globus pallidus or less commonly the subthalamic nucleus. In patients with cervical dystonia, surgery is usually performed bilaterally with electrodes placed on both sides of the brain.  After surgery, the electrical parameters of stimulation need to be set which is a process which is typically done gradually over several weeks and begins soon after surgery.

The benefit usually occurs gradually over hours to weeks. Up to 90% of patients who undergo this surgery see significant improvement with average improvement of about 50%.  Deep brain stimulation is usually performed in patients who have dystonia involving not only the neck but also other areas of the body or in patients who have severe complex dystonia with retrocollis, anterocollis, or complex jerking movements.

Deep brain stimulation is appropriate for patients who have an inadequate response to aggressive treatment with oral medications and botulinum toxin injections, those who have complex or difficult-­‐to-­‐treat cervical dystonia with retrocollis, anterocollis, or complex jerking, or those with more widespread dystonia.  Deep brain stimulation may adversely affect cognitive abilities and as a result, patients should have intact memory and thinking abilities prior to surgery in order to minimize the risk of significantly adversely affecting cognition.

On average deep brain stimulation improves symptoms about 50%.  The abnormal head position and tremulous movements may be improved, pain is typically markedly improved, and use of other medications may be reduced. Some patients who continue to respond to botulinum toxin injections prior to surgery may continue to receive injections but with an altered dose and pattern in order to maximize the benefit of the combined approach to treatment with both deep brain stimulation plus injection therapy.  As a result of these improvements, patients may lead a more normal life and may have improvement in mood and anxiety.

The most severe complication seen from deep brain stimulation is hemorrhage in the brain during the surgical procedure. This risk is approximately 1 to 2% for each side of the brain operated. The result is similar to that seen with stroke and may result in trouble with language, vision, paralysis, or rarely even death.  The implanted hardware may break or may become infected in up to 5 to 10% of patients at sometime during their lifetime.  Most of these hardware complications or infections typically occur in the first two or three months aYer surgery, but rarely may occur months or years later.  During the course of programming the stimulation parameters, numbness and tingling may occur in the body due to current spread to close-­‐by fibers conveying sensory information in the brain.  Similarly, slurred speech may occur due to occurring spread to the motor fibers to the face or throat.

Oral medications are usually used only in patients with more severe cervical dystonia who do not have an adequate response to treatment with botulinum toxin injections alone. Only a small minority, perhaps 20 or 25% of patients, demonstrate significant improvement with use of oral medications.

Dystonia Overview

Dystonia is a movement disorder that causes involuntary muscle spasms and contractions.  Dystonia may effect a single area of the body or throughout a group of muscles.  The American Dystonia Society estimates that as many as 300,000 people in North America are diagnosed with the disease.  Many dystonia patients have pain, muscle spasms, and cramping associated with the movement disorder.

Dystonia can affect patients at any age.  At early onset age, it is more likely that dystonia will become more severe and spread to other parts of the body.  If a patient has a late onset of dystonia, it is more likely that disorder will stay focal.  In addition to staying focal, if the dystonia spreads, it will likely only spread to adjacent segments.

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Treating Dystonia

Botulinum toxin injections are commonly used for the treatment of dystonia.  Botulinum toxin is injected into the affected muscle(s) causing them to relax .  This treatment typically provides approximately three months of relief.  Botulinum toxin injections may also reduce the paid associated with dystonia. These injections will need to be repeated over time as the effects wear off.  A rare portion of patients build an immunity to Botulinum toxin injections.

In the event oral medications and botulinum toxin injections are no longer working or if there are other debilitating factors involved, there are a few different types of surgical treatments available for dystonia.  The most recommended surgical option is Deep Brain Stimulation (DBS).  It should be noted that DBS surgery is rare in dystonia patients.

The following medications may be used in the treatment for dystonia: Anticholingerics, Benzodiazepines, Baclofen, Tetrabenzine, Dopaminergic agents, Dopamine-depleting agents

The benefits to treating dystonia are primarily to improve a patients quality of life as well as reducing pain.  Treating dystonia may be life-altering in such a way that it may allow a patient to engage in daily activities that a patient may otherwise not have been able to engage in.  These may include professional, personal, and recreational activities.

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Dystonia Education

This unique resource is designed to educate newly diagnosed patients and the general public about Dystonia.  The videos answer important questions about the disease itself, treatment options, and emerging research.  Dr. Kumar is a movement disorders specialist and clinical expert on movement disorders. He also serves as Medical Director for the Rocky Mountain Movement Disorders Center.

Learn All About Dystonia

Explore what dystonia is and how it effects the body.

Dystonia is a movement disorder characterized by sustained or intermittent muscle contraction usually involving agonist and antagonist muscles. This means that opposite acting muscles are simultaneously contracting which is sometimes called co-­‐ contraction. This causes abnormal posture or, repetitive movements, or both.

The movements are typically twisting and turning movements or patterned movements. There may be tremulous or tremor-­‐like movements superimposed, but usually the tremulous movements are irregular or jerky. Although some abnormal movements may persist at rest, the abnormal movements are generally worsened by voluntary movement. The patient may also have movement overflow in which abnormal movements are triggered by voluntary movement of a distant part of the body not affected by dystonia. The sustained twisting movement may cause muscular pain and even secondary orthopedic injury to patients. These later two features are most common in patients who have dystonia involving, or cervical dystonia.

It may be difficult to differentiate dystonia from other movement disorders. Amongst the most common difficulties is differentiating dystonia from tics. Individuals may have repetitive jerky movements sometimes with sustained abnormal postures as part of a tic disorder. Unlike dystonia, the tics are usually produced in response to an urge to make the movement and many patients can at least briefly suppress tics voluntarily unlike dystonic movements. Tics are often multi-­‐focal, occurring in one part of the body and then another. Tics tend to wax and wane. Patients may have motor tics in which abnormal movements are made and they may have vocal tics in which either formed words or said or other uterances occur such as sniffing or grunting. Most commonly, tics occur as part of Tourete syndrome which is a chronic motor and vocal tic disorder occurring with onset before the age of 18. Occasionally, tics can begin in adulthood and may be a purely motor disorder without vocal tics in which case the differentiation from dystonia can sometimes be more difficult.

Dystonia can often result in jerky, tremulous-­‐type movements and it is important to differentiate dystonic tremor from other forms of tremor. Tremor is generally defined as a rhythmic oscillatory movement produced by alternating contractions of opposite acting muscles. Dystonic tremor is usually irregular, unlike most other forms of tremor, and is usually produced by simultaneous or co-­‐contraction of opposite acting muscles. The most common forms of tremor are those seen as part of essential tremor and parkinsonian tremor. Patients with dystonic tremor usually have superimposed abnormal posture of the affected body part in addition to the tremulous movements. Isolated head tremor without tremor elsewhere in the body is usually due to cervical dystonia and dystonic tremor but is commonly misdiagnosed as essential tremor.

Causes & Characteristics

The Symptoms, Classifications and Causes of Dystonia

Dystonia can begin at any age; in childhood, during early adulthood, or even in one’s senior years. Age of onset is an important feature in helping to determine the potential prognosis as well as the underlying cause of dystonia. Patients with childhood onset more commonly have a genetic cause of dystonia and it is more likely that their dystonia may gradually spread from one part of the body to other parts of the body and may become generalized and more severe.  Patients with onset in middle to late years of life usually develop focal dystonia (such as affecting only the neck or the face) and although the dystonia may spread to some adjacent body parts such as from the neck to the face, spread to involve the limbs or entire body is very uncommon.

Many genes have been found to cause various forms of familial dystonia.  In the majority of cases, the dystonia tends to have onset in childhood or early adulthood. Typically many members of these families develop generalized dystonia. More recently, two or three genes have been discovered to cause focal or segmental cervical or craniocervical segmental dystonia. Most of the dystonia genes exhibit what is called reduced penetrants. This means that even if one harbors the genetic mutation, one may never develop symptoms. Indeed, in general only about 30 to 40 percent of individuals who have mutations in the various dystonia genes ever develop symptoms of dystonia during their life.

A minority of patients have acquired dystonia as a result of non-­‐genetic causes. Dystonia may occur as a result of brain injury occurring from head trauma or as a result of oxygen deprivation during birth. Other non-­‐traumatic causes such as brain tumors, strokes, or brain infection may also cause dystonia. Dopamine receptor blocking drugs such as those used to treat nausea and vomiting and others used to treat schizophrenia or depression may cause what is termed tardive dystonia. Lastly, dystonia may occur as part of a more widespread brain disorder in certain brain degenerative or metabolic diseases.

Idiopathic means that we have not yet discovered the cause. It is thought that most cases of idiopathic dystonia are, in fact, due to a genetic cause, but we have not yet discovered the specific gene mutations responsible for the patient’s dystonia. At present, the vast majority of patients have focal dystonia and specific genes are just now beginning to be discovered associated with certain forms of cervical dystonia. It is also possible that a small contribution of many genes may also be responsible for the development of dystonia in some patients, so-­‐called polygenetic inheritance.

Many Dystonia Treatments

Oral Medications, Botox Treatment, Surgery, Non-Drug Therapy

There are a variety of different oral medications which are used either alone or in combination with botulinum toxin injections or surgical treatment for patients with dystonia. By themselves oral medications generally are not very effective and are predominantly used in patients with more widespread or severe dystonia. These medications include anticholinergics such as trihexyphenidyl (known as Artane) and benztropine (known as Cogentin). Benzodiazepines include clonazepam which is also known as Klonopin, and diazepam which is more commonly known as Valium. Baclofen is a commonly used muscle relaxing type medication which blocks a neurotransmiHer known as GABA. Tetrabenazine is a medication which blocks dopamine. Lastly, levodopa is used selectively in patients who have a genetic form of dystonia known as dopa-­‐responsive dystonia in which there is a mutation in the gene important in the production of dopamine in the brain.

Selective injection of botulinum toxin weakens the overactive muscles into which it is injected and as a result reduces pain, spasm, and abnormal movement allowing the normally active muscles to bring the affected body part into a more normal posture. This is the treatment of choice for most patients with focal dystonia such as cervical dystonia and blepharospasm. Reducing the muscle spasm can significantly reduce pain especially in patients with cervical dystonia. The effect of these injections is not permanent. The effect typically comes on over several days with the peak effect in about 2 to ti weeks. The effect is temporary and wears off in about 3 months. As a result, patients usually require periodic injections about every 3 months. Use of botulinum toxin will be discussed in detail in additional presentations.

Surgical therapy is typically reserved for patients with substantial disability despite maximal treatment with oral medication and botulinum toxin injections. Surgery may be used in patient with focal dystonia or generalized dystonia, but only a small percent of patients with focal dystonia require surgical treatment. For patients with generalized dystonia, brain surgery involving implantation of electrodes into the brain to block abnormal signal know as deep brain stimulation is typically the treatment of choice. For patients with focal dystonia, deep brain stimulation may be used, but also peripheral surgery in which the overactive muscles are cut or the nerves supplying these muscles are cut to reduce the abnormal contractions may be used. Peripheral surgery is more commonly used in patients who have severe blepharospasm and cervical dystonia.

Speech, physical, and occupational therapy may be helpful for selected patients. Speech therapy is occasionally helpful as an additional treatment in addition to botulinum toxin injections in patients who have spasmodic dysphonia or dystonia involving the vocal cords. Physical therapy is often used to teach patients a stretching program to improve pain associated with muscle spasms and to stretch out the overactive muscles to prevent secondary orthopedic deformity and disability. Occupational therapy may be helpful with dystonia involves the limbs and affects gait and hand function.

Meet the Author and Practicing Clinician

Dr. Rajeev Kumar is one of the world’s foremost experts on movement disorders, with unparalleled experience and expertise treating and researching Parkinson’s Disease, Huntington’s Disease, Dystonia, and many other debilitating movement disorders. Trained at the renowned Mayo Clinic, Dr. Kumar has two decades of experience working in the fields of Neurology and Movement Disorders, and as Medical Director of the Rocky Mountain Movement Disorders Center and CNI Movement Disorders Center, he has solidified his status as one of the most trusted and respected professionals in the field.

Dr. Kumar, MD  Specializes in Treating Dystonia and Similar Movement Disorders including: General Dystonia, Cervical Dystonia, Miege Dystonia, Oromandibular Dystonia, Writer’s Cramp, Hemifacial Spasm and Essential Tremor .

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Will Botulinum Toxin Injections (Botox) Help Me?

80 to 90 percent of patients with focal dystonia are significantly improved with Botox injections. Patients with cervical dystonia experience a reduction in neck pain, abnormal head positioning, neck stiffness, and tremor/jerking, and are better able to turn the head. Patients with eye twitching or involuntary eye closure (blepharospasm) are substantially improved in 80 to 90 percent of cases, resulting in improvement in the ability to read, drive, and carry out day-to-day activities.

Writer’s cramp and other forms of limb dystonia may interfere with only one specific task or with many different tasks requiring manual dexterity. Selective injections can improve the use of the hands for writing, playing an instrument, typing or other activities.

Treatable Symptoms

  • Cervical dystonia – Abnormal neck posturing, often with superimposed jerky movements, may cause pain and embarrassment, and interfere with work, driving and social activities.
  • Blepharospasm – Eye twitching and involuntary eye blinking can interfere with reading, driving and many other day-to-day activities. These symptoms are commonly worse when patients are outside in sunlight.
  • Limb dystonia – Abnormal hand posturing may be task specific, sometimes occurring only when the patient is writing (writer’s cramp) or performing some other fine dexterous activity, such as typing or playing a musical instrument. The abnormal hand posturing may make it difficult or impossible to accomplish these tasks.

Treatment Methods

Botulinum toxin is injected specifically into the overactive muscles causing the foot cramps or eye twitching, or into the salivary glands for drooling. The effect comes on gradually over several days, with the peak effect reached in approximately 2 weeks. The benefit lasts for about 3 months. As a result, injections are repeated at 3 month intervals to maintain ongoing benefits.

Prognosis When Untreated

Dystonia usually slowly worsens over 2 to 3 years, and thereafter continues as a chronic disability. Remission is uncommon, occurring in less than 5 percent of cases.

Prognosis With Treatment

Botulinum toxin (Botox) injections effectively treat cervical dystonia in between 80-90 percent of patients, resulting in improvement in pain, neck position and quality of life. The injections can occasionally cause mild trouble swallowing or excessive neck weakness, but such side effects are typically mild and short lived. Injections are customized for each individual patient with respect to the specific muscles and the specific doses used, to maximize the benefits and to reduce the chance of any adverse effects.

Oral medications are helpful in less than 25 percent of patients, and rarely result in the immediate improvement seen with botulinum toxin injections. In patients with severe and more widespread dystonia (generalized dystonia), deep brain stimulation may provide additional therapeutic benefit.

Blepharospasm is improved with botulinum toxin injections in 80 to 90 percent of patients. Drooping of the eyelids or dry eyes may occur as adverse effects. If these side effects occur, they are usually mild and go away within 2 or 3 weeks. The specific pattern and dose of the injection into the muscles responsible for eye closing is customized in order to maximize benefits and minimize adverse effects.

Task specific limb dystonia (e.g. writer’s cramp or musician’s cramp) can be improved with highly customized injections of small amounts of Botox to selectively weaken the overactive muscles, without causes excessive weakness or reducing dexterity. When done by a highly experienced physician, this improves function in more than 75 percent of patients. Very low doses are typically needed in order to prevent grip weakness or impairment of other tasks.

Botulinum toxin injections are the first line and most effective treatment for 80 to 90 percent of patients with dystonia.

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Schedule a Consultation for Botulinum Toxin Treatment

In patients with Parkinson’s disease who are not currently Deep Brain Stimulation candidates; many of their mobility, and general movement issues can be improved with the use of Botox injections. With management of specific symptoms, patients’ quality of life can vastly improve in many different ways.Patients with different kinds of dystonia, can also benefit from the management of their different symptoms via Botox injections. They can regain their ability to walk, write, drive, and even live life with decreased pain.

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