Abstract
literature. Case report.– A 27-year-old patient, with PKAN heredodegenerative dystonia, has truncal dystonia symptomatology. Suddenly, she complained of low-back pain evaluated at 10/10 on a verbal scale. Low-back pain is induced by repetitive dystonic movements with upper limbs anterior elevation, spinal and hip extension (opisthotonos). Radiographs showed a L3 bilateral spondylolysis not shown in the previous radiographs. A classical corset immobilization isn’t possible because of movement disorders. A first botulinum toxin injection is performed (150 UI Botox) in lumbar paraspinal muscles for pain relief. Anterior head of deltoideus and gluteus maximus are also injected (for a total dose of 400 UI Botox each session) to break the extension scheme. Four weeks after injections, the pain is evaluated at 5/10 and movement disorders were less frequent. Thanks to the adapted wheelchair and the posterior articulars infiltration bilaterally (125 mg of hydrocortancyl), the patient is totally relieved. Because of pain recurrence, toxin injections are effectively renewed each 3 months. Discussion.– The increase of spondylolysis frequency is shown in CP patients [1], one of the most frequent pathology with dystonia. The effectiveness of botulinum toxin injections in spinal muscles to decrease contractions is hard to prove but some articles agree with a decrease of disorderedmovements and pain [2].
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