Sixty patients (30 men, 30 women, mean age 45.5 [18-71] years) with various forms of
spasmodic torticollis were treated with local
injections of botulinus A toxin. The results of treatment were assessed on an arbitrary scale (0-4) by the patients, by an examiner and by a neurologist who studied video recordings without knowing at what stage they had been recorded. After the first course of
injections (a maximum of three
injections of 10-40 ng in four weeks) 50 patients (83%) reported a better than 50% improvement; the mean score on the four point scale fell from 3.6 to 1.85 (P less than 0.001). The severity of the disorder as judged from the video recordings fell from a mean of 3.23 to 1.71 (P less than 0.001). The effect lasted for an average of 14 weeks. 6 patients developed mild
dysphagia, in two further cases severe
dysphagia occurred which lasted for up to four weeks. Twenty patients were followed up for more than one year: in nine of them the interval between courses of
injections, the dose being unaltered, remained the same (12-14 weeks), but thereafter the
abnormal movements returned with the same severity as before treatment. In eight patients the intervals between courses grew longer and the
abnormal movements became less severe. Two patients have been symptom free for 20 and 13 months respectively, but one female patient failed to respond owing to the presence of
antibodies against botulinus A toxin. The results indicate that local injection of botulinus toxin is a successful treatment for
spasmodic torticollis.