The exact pathophysiologic mechanisms of spasmodic torticollis and other idiopathic torsion dystonias remain largely unknown. Thus, a variety of drugs have been used alone or in combination on an empirical basis to treat these disorders, but to date none have efficacy that is proven and consistent. The drugs in use include anticholinergics, benzodiazepines, dopaminergics and dopamine antagonists with variable degrees of clinical improvement. Botulinum toxin A injection treatment for spasmodic torticollis is safe and efficacious with minimal adverse effect. However, it is expensive and beneficial effects are short-lasting. Only when a spasmodic torticollis patient's symptoms are refractory to combined treatment, using various drugs and Botulinum toxin injections, should the patient be considered a candidate for neurosurgical procedures.
Benzodiazepines/therapeutic use ; Botulinum Toxins/*therapeutic use ; Dopamine Agents/therapeutic use ; Dopamine Antagonists ; Human ; Parasympatholytics/therapeutic use ; Spasm/*drug therapy ; Torticollis/*drug therapy

OBJECTIVE[corrected] To evaluate efficacy and safety of botulinum toxin type B (BTX-B) in treatment of movement disorders including blepharospasm, oromandibular dystonia, hemifacial spasm, tremor, tics, and hypersecretory disorders such as sialorrhea and hyperhidrosis.

METHODSA retrospective study of BTX-B injections in treatment of 58 patients with various neurological disorders was performed. The mean follow-up time was 0.9 +/- 0.8 years. Results of the first and last treatment of patients with at least 3 injection sessions were compared.

RESULTSThe response of 58 patients to a total of 157 BTX-B treatment sessions was analyzed. Of the 157 treatment sessions, 120 sessions (76.4%) resulted in moderate or marked improvement while 17 sessions (10.8%) had no response. The clinical benefits after BTX-B treatment lasted an average of 14 weeks. Of the 41 patients with at least 3 injection sessions (mean 10 +/- 8.6), most patients needed increased dosage upon the last session compared to the first session. Nineteen patients (32.8%) with 27 sessions (17.2%) reported adverse effects with BTX-B treatment.

CONCLUSIONSThough most patients require increased dosage to maintain effective response after repeated injections, BTX-B is an effective and safe treatment drug for a variety of movement disorders, as well as drooling and hyperhidrosis.

Anti-Dyskinesia Agents ; administration & dosage ; therapeutic use ; Blepharospasm ; drug therapy ; Botulinum Toxins ; administration & dosage ; therapeutic use ; Botulinum Toxins, Type A ; Follow-Up Studies ; Humans ; Hyperhidrosis ; drug therapy ; Injections ; Meige Syndrome ; drug therapy ; Movement Disorders ; drug therapy ; Retrospective Studies ; Sialorrhea ; drug therapy ; Torticollis ; drug therapy