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Botulinum toxin injections are one of the main treatments for focal dystonia. The medication is injected directly into muscles involved in abnormal movement or posture, helping to reduce excessive muscle activity, pain and functional impairment.
Dystonia is a movement disorder characterised by involuntary muscle contractions, repetitive movements and abnormal postures. Symptoms may involve the neck, eyelids, face, jaw, hand, foot or several body regions.
Botulinum toxin temporarily reduces nerve signalling to the selected muscle. In dystonia, this makes it possible to weaken the muscles that contribute most strongly to the abnormal movement or posture.
The aim is not simply to “relax the muscles”, but to improve the balance between different muscle groups, reduce pain and improve movement or posture.
Involuntary turning, tilting, flexion or extension of the head, often accompanied by neck pain or head tremor. Botulinum toxin is one of the main treatments for cervical dystonia.
Bilateral involuntary contractions of the muscles around the eyes can cause excessive blinking, difficulty keeping the eyes open and significant functional visual impairment. Botulinum toxin can reduce the severity of these spasms.
Abnormal activity of muscles in the lower face, jaw or tongue can interfere with chewing, speech and jaw position. In selected forms, botulinum toxin can provide meaningful symptom control.
Botulinum toxin can be used for selected focal limb dystonias, including writer’s cramp, task-specific professional dystonias and some forms of foot dystonia.
In cervical dystonia, abnormal head position results from the activity of several neck muscles. Some patients predominantly turn the head, while others have tilting, forward flexion, backward extension or a combination of these patterns.
The neurological examination assesses not only the visible head position but also the direction of abnormal movement, head tremor, muscle hypertrophy, pain and compensatory movements.
The type of dystonia, abnormal movement pattern, pain and main functional limitations are assessed.
The muscles contributing most strongly to the abnormal posture or movement are identified.
Botulinum toxin is injected in small amounts into selected muscles. The number of injection sites and distribution of the dose depend on the individual clinical pattern.
After the effect develops, changes in abnormal movement, pain and function are evaluated. The next treatment cycle can then be adjusted.
Many superficial muscles can be identified using clinical examination and anatomical landmarks. For deeper muscles or complex movement patterns, additional guidance can improve localisation of the target muscle.
Depending on the clinical situation, ultrasound or electromyographic guidance may be used to support accurate placement of the injection.
Guidance is not required for every injection and does not replace careful clinical analysis of the dystonic movement pattern.
The effect of botulinum toxin develops gradually. Initial improvement is often noticed within several days, while the full clinical effect becomes clearer later.
The effect then gradually decreases over the following months. If symptoms return and treatment remains appropriate, injections can be repeated.
Treatment intervals and doses are individualised. Repeat treatment is often planned at intervals of approximately three months, although the timing depends on the duration of benefit, symptom severity and tolerability.
Subsequent injection patterns may be modified according to the response to previous treatment cycles.
Different botulinum toxin type A preparations are used in neurological practice. Each preparation has its own dosing system and clinical characteristics.
Side effects are usually related to the injection site or temporary weakness of nearby muscles.
Local discomfort, a small bruise or temporary muscle weakness may occur. The specific adverse effects depend on the area being treated.
Dr Lidiia Prakhova, MD, PhD, is a neurologist with clinical experience in the diagnosis of movement disorders and the use of botulinum toxin for neurological conditions.
In dystonia, careful analysis of the abnormal movement pattern is particularly important. The muscles selected for treatment and the distribution of the dose depend not only on the diagnostic label but also on the individual pattern of abnormal movement in each patient.
If you have already received botulinum toxin treatment, it is helpful to bring information about the product used, doses, injected muscles, date of the previous procedure and duration of benefit.
Consultations are available in Israel. Previous medical records, neurological reports and information about earlier injection cycles can help in planning further treatment.
Involuntary facial movements are not always caused by dystonia. Blepharospasm is a focal dystonia, while hemifacial spasm is usually related to abnormal activity of the facial nerve and is considered a separate neurological disorder.
Botulinum toxin can be effective in both conditions, but diagnosis, target muscles and treatment goals are different.
Yes. Botulinum toxin is one of the main treatments for cervical dystonia and for many other focal dystonias in which specific overactive muscles can be identified.
Initial improvement is usually noticed within several days after treatment. The clinical effect develops gradually and can continue to increase over the following weeks.
Treatment is often repeated at intervals of approximately three months, although the optimal interval varies depending on the duration of benefit and the individual clinical situation.
No. Many muscles can be treated using clinical examination and anatomical landmarks. Ultrasound or EMG guidance may be particularly useful for deep muscles, complex patterns or when more precise localisation is needed.
Patients with the same diagnosis may have very different combinations of active muscles. Muscle selection and dosing therefore need to reflect the individual movement pattern.
In some situations this may be appropriate, but different products use different dosing systems. Their units are not equivalent, so dosing must be reconsidered individually.
If you have involuntary turning or tilting of the head, eyelid spasms, abnormal movements of the hand or foot, or an established diagnosis of dystonia, a neurological consultation can help define the movement pattern and determine whether botulinum toxin treatment is appropriate.
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