From the Research
For secondary muscle injection treatment, I recommend using botulinum toxin (Botox, Dysport, Xeomin) as the primary option, with dosages typically ranging from 50-400 units depending on the specific muscle group and condition being treated, as supported by the most recent study 1. The injection should be administered directly into the affected muscle using a 25-30 gauge needle, with effects typically lasting 3-6 months before requiring repeat treatment.
- Key considerations for treatment include:
- Confirming the target muscle using anatomical landmarks, ultrasound guidance, or EMG for precision, as suggested by 2.
- Monitoring patients for 15-30 minutes for adverse reactions and advising them to avoid massage or excessive activity of the treated area for 24 hours.
- Considering phenol (5-6% solution) or alcohol (50-100%) injections as alternatives for conditions not responding to botulinum toxin, though these carry higher risks of tissue damage. These treatments work by temporarily blocking neuromuscular transmission (botulinum toxin) or causing controlled chemical denervation (phenol/alcohol), effectively reducing muscle hyperactivity, spasticity, or dystonia.
- Secondary muscle injections are particularly effective for focal muscle problems when primary treatments have failed or as adjuncts to physical therapy in conditions like cerebral palsy, stroke-related spasticity, or cervical dystonia, as noted in 3, 4, 5. The most recent study 1 highlights the importance of rehabilitation therapy, including exercise therapy, transcranial magnetic stimulation, shockwave therapy, neuromuscular electrical stimulation, vibration therapy, electromyographic biofeedback, and acupuncture, as adjunctive treatments for spasmodic torticollis.