The Updates of Managing Cervical Dystonia/Movement Disorders with Botulinum

Botulinum toxin is a neurotoxin protein produced by the bacterium Clostridium botulinum. Being one of the most poisonous naturally occurring substances and the most toxic protein, it has become one of the most widely used and most effective therapeutic agents ever invented. Botulinium toxin type A was first used in human strabismus in 1980. In less than three decades, its applications have expanded greatly. Nowadays it is used to treat all kinds of dystonic or non-dystonic muscle spasm, sphincter problems, headache, excessive sweating or salivation, spasticity of all sorts, and facial wrinkles. Dystonia has been the first movement disorder treated with botulinum toxin. However, the use of botulinum toxin has encompassed many other hyperkinetic movement disorders, such as tremor, tics, tardive dyskinesias, and bruxism. This tremendous explosion in the use of botulinum toxin is attributed to its effectiveness and relative lack of severe side-effects. For this agent, the discovery of new and novel uses is limited only by our own creativity. During clinical practice, it is advisable to keep some points in mind before commencing botulinum toxin treatment. The principal symptom being targeted should be clear. For example, is botulinum toxin given to relieve pain, or to correct abnormal posture, or both? Muscles that are principally causing the symptom(s) are then identified. A sufficient dose should be injected into each muscle. The main goal of botulinum toxin injection is to maximise benefit and to limit potentia