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Parkinson's Disease

Spasmotic Torticollis

05/21/1999

Question:

I am currently receiving Botox injections for spasmodic torticollis. The injections are not working as well as they did in the beginning. What other treatments are available ?

Answer:

Possible explanations include: 1. Development of antibodies to Botox. 2. Disease progression requiring a higher dose. 3. Technical errors in injecting Botox especially if EMG guidance was not used.

Possible options include: 1. Receiving higher doses or receiving injections from another practitioner; even with EMG guidance there can be variations based on technique. 2. Using oral medications against dystonia such as Baclofen, Tizanidine, Artane or Klonopin in addition to the Botox. 3. Botox F is available at a few centers under a research protocol for patients failing to respond to Botox A (the presently marketed form). 4. Selective rhizotomy, a kind of surgery that lesions nerve roots supplying the muscles affected. 5. Pallidotomy or pallidal stimulation, a kind of surgery that changes feedback loops in the brain that are responsible for dystonia. 6. Intrathecal baclofen that involves injecting baclofen into the cerebrospinal fluid with a pump placed inside the body.

Please discuss these options with your neurologist who should be able to guide you to the option(s) most indicated for your condition.

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Response by:

Arif Dalvi, MD
Assistant Professor
College of Medicine
University of Cincinnati