Treatment of Dystonic Pain with Botulinum Neurotoxins

Abstract

Focal dystonia is a common neurological disorder which is often painful. This chapter reviews clinical features of three common and painful focal dystonias, namely, cervical dystonia, focal dystonia associated with neurodegenerative disorders, and post-traumatic dystonia. The literature on the efficacy of botulinum toxins for these three forms of dystonic pain is reviewed. Fourteen blinded and placebo-controlled clinical trials assessed pain at baseline and after BoNT treatment of cervical dystonia. All 14 reported efficacy against pain. CD-related pain responded also to all three types of A neurotoxins as well as the type B neurotoxin. Small retrospective studies and clinical observations demonstrate that currently available neurotoxins (A or B) improve pain of Parkinson-related dystonias (toe flexion and foot inversion) as well as painful post-traumatic dystonias. Blinded studies for these indications are not available. Case reports and short videotape clips from author’s experience are provided to demonstrate patients’ histories and the technique of BoNT administration.