Abstract
Selection of muscles for botulinum toxin injection for limb dystonia is particularly challenging. Limb dystonias vary more widely in the pattern of dystonic movement and involved muscles than cervical dystonia or blepharospasm. The large variation in how healthy individuals perform skilled hand movements, the large number of muscles in the hand and forearm, and the presence of compensatory actions in patients with dystonia add to the complexity of choosing muscles for injection. In this article, we discuss approaches to selecting upper and lower extremity muscles for chemodenervation treatment of limb dystonia.
Highlights
Focal hand dystonia is a condition of early-late adulthood; the usual age of onset is in the 4th–5th decade [2,3]
Adult onset focal limb dystonia frequently evolves to its full expression over weeks to months
The dystonic movements were alleviated by local injection of lidocaine for as long as 24 h, relieve dystonia [37,38,39,40], it is of limited therapeutic value for dystonia as the benefit is short-lasting
Summary
The current definition of dystonia describes it as “a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures, or both. Dystonia is often initiated or worsened by voluntary action and associated with overflow muscle activation [1]” These features are exemplified by focal hand dystonia, especially those that are task-specific. Axis I of the 2013 revised consensus criteria for dystonia includes five descriptors: age at onset, body distribution, temporal pattern, and coexistence of other movement disorders and other neurological manifestations [1]. Within this nosology, focal hand dystonia is a condition of early-late adulthood; the usual age of onset is in the 4th–5th decade [2,3]. In task-specific focal limb dystonia, the muscles affected typically encompass those used during a repetitive activity. Musician’s dystonia has been associated with more anxiety, stress and perfectionism compared to musicians without dystonia [26]
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