Effect of botulinum toxin in disabling ectatocormia

Abstract

Ectatocormia (severe, fixed truncal hyperextension exacerbated by movements of the trunk) is associated with pain and motor disability, and impide the patient to maintain a normal upright posture or to walk. The aim of this report is to present the case of an adult with ectatocormia and the changes in pain and posture after botulinum toxin administration to paraspinal muscles. A 28-year-old patient with congenital ataxia and trunk dystonia in hyperextension predominantly lumbar and left inclination. Presents pain, difficulty in sitting and walks with assistance from a person less than 10 meters indoors. Prior informed consent is treated with botulinum toxin type A, that was obtained in 100 u vials as Botox (Allergan Pharmaceuticals) and reconstituted with 2 mL of normal saline. The patient was placed prone with a cushion under the pelvis. Muscles were injected with ultrasound guidance and convex probe in three sites on each side, using a spinal needle and administrating 60 u at each site: 20 u multifidus, 20 u longissimus and 20 u iliocostalis at the level of the eleventh thoracic vertebrae, second and fourth lumbar vertebraes. Left quadratus lumborum muscle also received 40 u. The score reported by the parents in the Global Dystonia Severity Rankin Scale went down from 10 (pre-injection) to 5 (post-injection). Pain reduction was recorded indirectly by reporting of the parents who perceived the patient more relaxed and more smiling. An upright sitting without dorsal support/with support on hands was achieved of more than 10 seconds and a decrease in left inclination. No adverse effects were reported. The administration of botulinum toxin type A in the paraspinal muscles seems to be an effective treatment to reduce truncal hyperextension, besides the pain and disability that it produces.