Botulinum Therapy for Dystonia
Botulinum toxin therapy is one of the most effective and safe methods for treating various forms of dystonia . The method is based on targeted injection of botulinum toxin into overactive muscles in order to relax them, reduce pathological activity and improve the patient’s quality of life.
Dr. Lidiia Prakhova has extensive experience in diagnosing and treating different types of dystonia, including severe and rare forms, and performs high-precision injection treatment using anatomical landmarks, ultrasound guidance and EMG. In many cases botulinum therapy is the first-line treatment for focal dystonias.
- Which dystonias are treated with botulinum therapy
- Cervical dystonia (spasmodic torticollis)
- Blepharospasm
- Hemifacial spasm
- Dystonias of the limbs
- Advantages of botulinum therapy
- How the procedure is performed
- When botulinum therapy is recommended
- Possible side-effects
- Consultations & appointments
- FAQ about botulinum therapy for dystonia
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Which dystonias are treated with botulinum therapy
Botulinum toxin injections are used to treat a wide range of focal and segmental dystonias. The goal is to reduce abnormal muscle contractions, relieve pain and improve everyday functioning. In many cases botulinum therapy helps to avoid long-term use of systemic medications with more pronounced side-effects.
Cervical dystonia (spasmodic torticollis)
Cervical dystonia is the most common form of focal dystonia. It manifests as:
- pathological head turn (torticollis);
- head tilt (laterocollis);
- excessive extension (retrocollis) or flexion (anterocollis);
- neck pain, muscle tension, headaches.
Botulinum therapy is considered a first-line treatment and allows a significant reduction of spasm and pain and improvement of head position. More details about the mechanisms and types of cervical dystonia can be found in the dedicated article “Dystonia: diagnosis and treatment” .
Blepharospasm
Blepharospasm is characterized by bilateral involuntary spasms of the orbicular eye muscle:
- frequent blinking;
- “crinkling” of the eyes;
- difficulty opening the eyelids;
- photophobia and tearing.
Botulinum toxin in small doses is injected into the orbicular muscle of the eye and provides long-lasting control of symptoms (usually for 3–4 months), improving visual function and everyday comfort.
Hemifacial spasm
Hemifacial spasm is manifested by involuntary contractions of muscles on one half of the face:
- eyelid twitching;
- spasms of the cheek or mouth;
- facial asymmetry;
- social and functional discomfort.
Injections are performed in key facial muscles, which reduces spasm without significantly affecting facial symmetry and natural expression.
Dystonias of the limbs
Limb dystonias may include:
- writer’s cramp;
- musician’s dystonias;
- focal spasms of the forearm and hand;
- dystonias of the foot.
Botulinum therapy makes it possible to restore precision of movement, reduce painful spasm and improve hand or foot function. In many cases it allows patients to return to work or creative activity.
Advantages of botulinum therapy
When dystonia is correctly diagnosed, botulinum therapy offers several important advantages:
- High efficacy — significant reduction of spasms in most patients.
- Minimal side-effects with proper injection technique.
- Local action — no systemic impact on the whole body.
- Proven safety with many years of clinical use.
- Flexible dosing tailored to individual patient characteristics and treatment goals.
- Short procedure time and quick return to normal daily activity.
Botulinum therapy is often combined with physiotherapy, occupational therapy and, when needed, oral medications. For patients with chronic migraine a separate protocol of botulinum therapy is used — learn more about botulinum therapy for migraine .
How the procedure is performed
Botulinum therapy for dystonia includes several stages:
- Neurological consultation: assessment and clarification of the dystonia type, exclusion of other neurological or ophthalmological conditions, analysis of MRI/EMG data if necessary.
- Selection of target muscles and treatment plan: drawing up an injection map, discussion of expected effect and possible side-effects.
- Choice of preparation and dosage: original preparations are used — Botox®, Dysport®, Xeomin® — depending on the clinical task and previous treatment experience.
- Injections: injections into selected muscles using a thin needle; the procedure usually takes 10–20 minutes. Injections are performed under ultrasound guidance and, when needed, with EMG guidance, which significantly increases accuracy and safety.
- Effect: first results appear within 3–7 days; the full effect is reached by day 10–14. The duration of action is usually 3–4 months, after which the procedure can be repeated.
When botulinum therapy is recommended
Botulinum toxin injections are usually recommended when one or more of the following are present:
- pronounced or painful spasms that interfere with everyday activities;
- abnormal head position or eye closure due to dystonia;
- impaired writing, work or daily self-care;
- insufficient effect or poor tolerance of oral medications;
- cosmetically significant facial asymmetry in facial dystonias.
The decision about botulinum therapy is made individually after a neurological examination. In some cases a combination of botulinum therapy with other methods of treatment is optimal.
Possible side-effects
Side-effects after botulinum therapy are rare and, as a rule, reversible:
- mild weakness of muscles adjacent to the injection area;
- tenderness or small bruises at the injection site;
- transient asymmetry of facial expression.
With correct choice of muscles, dose and injection technique the risk of complications is minimal. At the consultation Dr. Prakhova explains in detail which side-effects are possible in your particular case and how they are monitored.
Consultations & appointments
Consultations (and botulinum therapy sessions) are carried out at the outpatient clinic of Shamir Medical Center (Assaf Harofeh).
Adult patients (18+) are accepted.
For an appointment:
???? 08-977-97-75, 08-977-91-45
✉ neuro@shamir.gov.il,
089779758@shamir.gov.il
FAQ about botulinum therapy for dystonia
Is botulinum therapy used only for cosmetic purposes?
No. In neurology botulinum toxin is an evidence-based and widely used treatment for many forms of dystonia, spasticity and chronic migraine. Cosmetic indications are only one area of its application. In cervical dystonia, blepharospasm and hemifacial spasm botulinum therapy is often the standard of care.
How often do I need to repeat injections?
On average the effect lasts about 3–4 months. The interval between procedures is selected individually, taking into account how quickly symptoms return. Too frequent injections are not recommended, as the effect may decrease.
Is the procedure painful?
Most patients describe the sensations as mild discomfort or a “pinprick”. A thin needle is used, and injections are performed quickly. If necessary, topical anesthetic cream can be applied to the skin before the procedure.
Can botulinum therapy be combined with other treatments?
Yes. Botulinum toxin injections are often combined with physiotherapy, occupational therapy, orthoses, oral medications and lifestyle changes. The treatment plan is discussed individually during the consultation.
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Shamir Medical Center (Assaf Harofeh) — Neurological Institute (Appointments & Contact)
