Journal of Movement Disorders

Original Article

Effective Botulinum Toxin Treatment in Patients With Different Patterns of Cervical Dystonia: A Retrospective SPECT and EMG Study: Hongkai Gu, Yougui Pan, Lizhen Pan, Xiaolong Zhang, Ronghua Hong, Zhuang Wu, Chenghong Wang, Shuzhen Chen, Lingjing Jin, Fei Teng; Received July 15, 2025 Accepted November 19, 2025 Published online November 19, 2025; DOI: https://doi.org/10.14802/jmd.25186 [Epub ahead of print]

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Abstract PDF: Objective
The Col-Cap classification for cervical dystonia (CD) has been proposed to optimize treatment strategies with botulinum toxin type A (BTX-A). Although this concept has been used for 15 years, the efficacy of BTX-A in various CD patterns remains unclear. The present study compared the efficacy of BTX-A, aided by single-photon emission computed tomography (SPECT) and electromyography (EMG), in various CD patterns.
Methods
CD patients who underwent SPECT scans to detect dystonic muscles were included. Candidate muscles were first selected based on clinical evaluation and abnormal radioactivity on SPECT imaging. All patients were injected under the guidance of EMG, and only candidate muscles with positive EMGs were injected. The efficacy of BTX-A was assessed via the subjective clinical improvement rate and the reduction in the Tsui score at four weeks after injection.
Results
The study enrolled 252 patients. The subjective improvement rates were 63.5%±20.6% for simple types and 59.9%± 22.2% for complex types, and this difference was not significant (p=0.247). The reduction rates of the Tsui score did not differ between the simple type (52.4%±24.2%) and the complex type (49.6%±23.6%, p=0.556). Moreover, clinical improvement rates did not significantly differ within each group of simple subtypes, complex subtypes, or patients with different types of tremors (p>0.05).
Conclusion
The efficacy of BTX-A treatment was comparable in different CD patterns because of the appropriate selection of dystonic muscles via SPECT and EMG. Therefore, employing multifaceted approaches to identify dystonic muscles can yield favorable outcomes, even in complex cases.

Brief communication

Long-Term Outcome of Hemimasticatory Spasm: Somdattaa Ray, Nitish Kamble, Ravi Yadav, Pramod Kumar Pal; J Mov Disord. 2022;15(2):146-150. Published online March 16, 2022; DOI: https://doi.org/10.14802/jmd.21067

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Objective
This study aims to identify the demographic, clinical, and therapeutic characteristics of four patients with hemimasticatory spasm (HMS) seen in our outpatient department over a period of 20 years.
Methods
We performed a retrospective chart review of four patients with HMS who visited outpatient services in the Department of Neurology from 2001 to 2020.
Results
The follow-up for all patients ranged from 2 years to 9 years. Three patients had facial or bucco-oral morphea. Two patients maintained long-term improvements in symptoms after being treated with botulinum toxin for 4–7 years, while one patient reported improvement in symptoms with treatment of carbamazepine that subsequently remitted after pregnancy.
Conclusion
This report highlights the long-term outcome of HMS in our patients. Our patients reported a significant reduction or complete resolution of symptoms after treatment, and eventually, two patients were asymptomatic while off treatment.

Citations

Citations to this article as recorded by

Hemimasticatory spasm: a series of 17 cases and a comprehensive review of the literature
Kazuya Yoshida
Frontiers in Neurology.2024;[Epub] CrossRef
Hemimasticatory Spasm Treated With Muscle Afferent Block Therapy and Occlusal Splint
Kazuya Yoshida
Journal of Movement Disorders.2024; 17(2): 230. CrossRef
Peripherally induced movement disorders in the stomatognathic system after oral surgical or dental procedures
Kazuya Yoshida
Oral and Maxillofacial Surgery.2024; 28(4): 1579. CrossRef
The progress in epidemiological, diagnosis and treatment of primary hemifacial spasm
Guangfa Xiang, Minghong Sui, Naifu Jiang, Rui Luo, Jianwei Xia, Xinling Wei, Yifeng Lin, Xingyu Li, Zixiang Cai, Junxia Lin, Shipei Li, Wanyi Chen, Yang Zhao, Lin Yang
Heliyon.2024; 10(19): e38600. CrossRef
Peripherally-induced Movement Disorders: An Update
Abhishek Lenka, Joseph Jankovic
Tremor and Other Hyperkinetic Movements.2023;[Epub] CrossRef

Original Articles

Patient Knowledge, Attitude and Perceptions towards Botulinum Toxin Treatment for Movement Disorders in India: Thavasimuthu Nisha Mol, Nitish Kamble, Vikram V. Holla, Rohan Mahale, Pramod Kumar Pal, Ravi Yadav; J Mov Disord. 2021;14(2):126-132. Published online April 26, 2021; DOI: https://doi.org/10.14802/jmd.20094

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116 Download
1 Web of Science
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Abstract PDF Supplementary Material

Objective
There is limited literature on the knowledge, attitude, and perceptions (KAP) of botulinum toxin (BoNT) treatment among patients and caregivers. The objective of this study was to assess the KAP in patients undergoing BoNT treatment for movement disorders.
Methods
One hundred patients with movement disorders from National Institute of Mental Health and Neurosciences Hospital in Bengaluru, South India, were recruited. The patients underwent demographic, clinical, and Patient Knowledge Questionnaire on Botulinum Toxin Use in Movement Disorders (PKQ-BMD)-based evaluations.
Results
The mean age of patients at the time of presentation was 47.97 ± 14.19 years (range, 12–79). Of all the patients, 26 (28%) patients were anxious, and 86% of these patients were reassured after appropriate counseling. There were 83 (89%) patients who found BoNT to be a costlier option. Education and previous Internet searches influenced positive performance in the “knowledge” domain and overall PKQ-BMD scores. The “number of injections” was also positively correlated with KAP performance.
Conclusion
This study showed that knowledge and perceptions about BoNT treatment need to be further improved. Wider availability of the Internet has provided a positive impact on patients’ and carers’ KAP. Internet-based information, higher educational qualifications of the patients, and a higher number of BoNT injection sessions are the most important predictors of satisfactory KAP related to BoNT injection treatment in patients with movement disorders.

Citations

Citations to this article as recorded by

Barriers to providing movement disorders care in India
Heli Shah, Prashanth Lingappa Kukkle
Current Opinion in Neurology.2025; 38(4): 361. CrossRef

Sensory Trick Frames: A New Device for Blepharospasm Patients: Daniele Lorenzano, Steven Tansley, Daniel G. Ezra; J Mov Disord. 2019;12(1):22-26. Published online January 16, 2019; DOI: https://doi.org/10.14802/jmd.18010

12,716 View
201 Download
6 Web of Science
7 Crossref

Abstract PDF

Objective
To determine whether the use of unique customized spectacles provided with modified side arms may be helpful in reducing benign essential blepharospasm (BEB) in patients describing periocular sensory tricks (ST).
Methods
A prospective descriptive study of patients with BEB with positive periocular or temporal region ST phenomenon response under the care of the Botox Clinic at Moorfields Eye Hospital, London, UK. Nine consecutive patients with BEB describing ST were recruited, and the disease frequency and severity were assessed with the Jankovic Rating Scale (JRS) and the Blepharospasm Disability Index (BSDI) before and after the use of the sensory trick frames (STF).
Results
A reduction in the score was noted in both severity (p = 0.0115) and frequency patterns (p = 0.0117) in the JRS in patients using the STF. A significant reduction of the BSDI score was also observed (p = 0.0314).
Conclusion
All the patients selected and fitted with the STF had a reduction in spasms and related symptoms. This new device may be helpful in some selected BEB patients who previously responded positively to periocular pressure alleviating maneuvers.

Citations

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Electrically Induced Sensory Trick in a Patient with Musician’s Dystonia: A Case Report
Daisuke Nishida, Katsuhiro Mizuno, Osamu Takahashi, Meigen Liu, Tetsuya Tsuji
Brain Sciences.2023; 13(2): 223. CrossRef
Evaluation of Blepharoptosis in Patients With Refractory Blepharospasm by VISA—Video Recordings, Idiosyncratic Expressions, Sensory Tricks, and Ancillary Procedures
Chung-Sheng Lai, Savitha Ramachandran, Chia-Chen Lee, Ya-Wei Lai, Yang-Pei Chang, Shu-Hung Huang
Annals of Plastic Surgery.2023; 90(5S): S172. CrossRef
Variability of Movement Disorders: The Influence of Sensation, Action, Cognition, and Emotions
Rok Berlot, John C. Rothwell, Kailash P. Bhatia, Maja Kojović
Movement Disorders.2021; 36(3): 581. CrossRef
Impact of Upper Eyelid Surgery on Symptom Severity and Frequency in Benign Essential Blepharospasm
Hannah Mary Timlin, Kailun Jiang, Daniel George Ezra
Journal of Movement Disorders.2021; 14(1): 53. CrossRef
Benign essential blepharospasm: epidemiology, clinical manifestations, pathophysiology, botulinum toxin therapy
Z. A. Zalyalova
Neurology, Neuropsychiatry, Psychosomatics.2021; 13(1): 119. CrossRef
Best Practices in the Clinical Management of Progressive Supranuclear Palsy and Corticobasal Syndrome: A Consensus Statement of the CurePSP Centers of Care
Brent Bluett, Alexander Y. Pantelyat, Irene Litvan, Farwa Ali, Diana Apetauerova, Danny Bega, Lisa Bloom, James Bower, Adam L. Boxer, Marian L. Dale, Rohit Dhall, Antoine Duquette, Hubert H. Fernandez, Jori E. Fleisher, Murray Grossman, Michael Howell, Di
Frontiers in Neurology.2021;[Epub] CrossRef
Ocular motor manifestations of movement disorders
Grace F. Crotty, Bart K. Chwalisz
Current Opinion in Ophthalmology.2019; 30(6): 443. CrossRef

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