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8054 Yonge St. Thornhill. Just south of the intersection of Yonge and HWY 7/407

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Botulinum Toxin Injections for Cervical Dystonia

Cervical dystonia is a neuromuscular disorder that causes painful and sudden muscle spasms or movements in the neck. It has a sudden onset, but the intensity of the muscle spasms will gradually intensify if left untreated.

The use of botulinum toxin injections as a way to treat cervical dystonia has been approved since 2000 and has proven to be the most effective way to manage this disorder.

What is Cervical Dystonia?

Dystonia is the medical term used to describe abnormal and sudden muscle spasms that result in painful and repetitive movements or postures (Pana & Saggu, 2023). The addition of cervical to dystonia indicates the area affected. Cervical dystonia (CD), also known as spasmodic torticollis, is the most common type of dystonia and can be accompanied by other types of dystonia.

There are two types of CD, acquired and primary. It is more often seen in women/AFAB between 30 and 50 years old (Kilic‐Berkmen et al., 2021). Recent research has highlighted the possibility of a genetic factor in the development of CD (Siokas et al., 2018).

The most common cause of acquired CD is a traumatic head, neck, or upper spine injury. Some medications, such as anti-seizure drugs, may also cause this type of CD. However, primary CD is thought to be caused by a genetic issue and is most often seen in adults.

CD is considered to be a neurological disorder, where the muscles receive sudden and abnormal signals from the brain, causing sudden muscle spasms. However, the exact mechanism of action of CD is still being researched.

The symptoms of CD start gradually before getting worse if left untreated. Long-term untreated CD may cause permanent damage to the neck and cervical spine. The main symptom of CD is twisting of the head towards the chin, shoulder, or straight down. It may disappear on its own before returning with greater intensity. The diagnosis of CD is based primarily on the physical symptoms seen during an examination.

Children with cerebral palsy may develop CD as a secondary symptom.

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Botulinum Toxin Injections: Effective Pain Management for Cervical Dystonia

The introduction of a safe and purified strain of Clostridium botulinum, the bacteria responsible for botulism food poisoning, into the body through an, or a series of, injection(s) is known as botulinum toxin injections (BTI). These bacteria create a substance that acts on the muscle receptors and prevents acetylcholine, a neurotransmitter, from binding to its receptors (Padda & Tadi, 2023).

By blocking the acetylcholine from binding to the muscle receptors, it prevents those muscles from contracting, forcing them into a state of relaxation. This is also referred to as muscle paralysis. Through this effect, strained muscles can rest and recover from any injuries that may be causing pain.

Furthermore, blocking acetylcholine from attaching to nerves reduces its ability to transmit pain signals to the brain. This leads to less overall pain as the brain doesn’t receive those signals.

BTI is a good pain management option for people with muscle- or nerve-related pain issues, especially if other treatments haven’t provided good results. It provides long-term pain relief through a minimally invasive procedure with few side effects.

Benefits of Botulinum Toxin Injections for Cervical Dystonia Patients

The use of BTI for CD has been approved since 2000 and is considered the best treatment for this disorder (Jankovic et al., 2023). Treating CD with BTI has been shown to reduce pain, and the risk of long-term and permanent side effects of untreated CD, and improve the overall quality of life of patients. While somewhat invasive, BTI is safe and recommended as the first treatment in a CD treatment plan.

What To Expect During Botulinum Toxin Treatment for Cervical Dystonia

BTI is a series of injections in and around a specific area, usually at the source of pain, by a trained medical professional (Rodrigues et al., 2020). On average, a Botox treatment takes 3 to 4 days to take effect and 2 weeks before it achieves its optimal effect.

When used to treat CD, BTI reduces the intensity and length of muscle spasms. It will also reduce the pain from tense, sore, or injured muscles. Finally, the use of BTI to treat CD has been shown to improve the overall quality of life of patients.

It can last up to 12 weeks, though the exact length of its effects will vary from one person to another. Your medical team will determine the frequency of your treatments.

Side Effects

As with anything else, BTI can have side effects, some of which can be dangerous (Padda & Tadi, 2023). Most side effects are benign and will quickly disappear on their own. These side effects include discomfort at the injection site, mild headaches, fatigue, flu-like symptoms, and nausea or vomiting.

Some side effects can take up to 2 weeks to disappear: drooping eyelids, excessive salivation, and mild facial paralysis. Some more serious side effects may require medical assistance, such as long-term dry eyes or an infection.

However, there are serious side effects that require immediate medical attention. If you experience any difficulties breathing, swallowing, or speaking; sudden generalized muscle weakness; and/or sudden issues with your vision, please call your emergency services. These serious side effects are rare.

Wilderman Medical Clinic

Wilderman Medical Clinic offers Botox Injections as part of its pain management clinic.

Please note that the Ontario Ministry of Health covers BTI injections only for certain categories of patients, for example, seniors, patients in the Ontario Disability Program, and Ontario Works. WSIB and private insurance companies may cover the injections under their guidelines.

Works Cited

Jankovic, J., Tsui, J., & Brin, M. F. (2023). Treatment of cervical dystonia with Botox (onabotulinumtoxinA): Development, insights, and impact. Medicine, 102(S1), e32403.

Kilic‐Berkmen, G., Richardson, S. P., Perlmutter, J. S., Hallett, M., Klein, C., Wagle‐Shukla, A., Malaty, I. A., Reich, S. G., Berman, B. D., Feuerstein, J., Vidailhet, M., Roze, E., Jankovic, J., Mahajan, A., Espay, A. J., Barbano, R. L., LeDoux, M. S., Pantelyat, A., Frank, S., . . . Jinnah, H. A. (2021). Current guidelines for classifying and diagnosing cervical dystonia: Empirical evidence and recommendations. Movement Disorders Clinical Practice, 9(2), 183–190.

Padda, I. S., & Tadi, P. (2023, November 6). Botulinum toxin. StatPearls – NCBI Bookshelf.

Pana, A., & Saggu, B. M. (2023, September 4). Dystonia. StatPearls – NCBI Bookshelf.

Rodrigues, F. B., Duarte, G. S., Marques, R., Castelão, M., Ferreira, J. J., Sampaio, C., Moore, A. P., & Costa, J. (2020). Botulinum toxin type A therapy for cervical dystonia. Cochrane Library (CD-ROM), 2020(11).

Siokas, V., Aloizou, A., Tsouris, Z., Michalopoulou, A., Mentis, A. A., & Dardiotis, E. (2018). Risk Factor Genes in Patients with Dystonia: A Comprehensive Review. PubMed, 8, 559.


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