Botulinum toxin injections for cervical dystonia

Botulinum toxin injections for cervical dystonia (neck
dystonia, spasmodic torticollis)
Turnberg Building
Neurology
0161 206 2562
© G15110603W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2015.
Document for issue as handout. Unique Identifier: NOE56(15). Review date: November 2017
About botulinum toxin injection for cervical dystonia
Cervical dystonia is a condition
in which the muscles of the neck
go into spasm; the spasm can
last for a few seconds to several
minutes, and can sometimes be
virtually continuous.
This can make it difficult to
stop your head from turning
to the side, tipping forward or
backwards. Cervical dystonia can
also cause tremor of the head.
It may not be possible to stop
the spasm completely.
Before your procedure
A neurologist will review you
in the outpatients department.
The procedure will be discussed
and a decision will be made
on the site and number of
injections that are required.
Details of your medical history
will be taken, if necessary
a clinical examination and
investigations will be carried
out. This is a good opportunity
for you to ask any questions
about the procedure or any
concerns you may have.
These symptoms are often
temporarily relieved by
injecting botulinum toxin into
selected muscles of the neck.
Botulinum toxin is an effective
way to control the symptoms
caused by neck spasm and
works well in the majority of
affected individuals.
The effect of the injection lasts
for two to three months only,
and repeated injections are often
necessary for continued relief.
In cases where little improvement
results from the injections,
it may be because different
muscles need to be targeted, or
the dose needs adjusting.
You will be asked if you
are taking any prescribed
medication or any tablets
bought over the counter in a
pharmacy. It helps if you bring
your tablets to the appointment.
continued page 2
© G15110603W. Design Services, Salford Royal NHS Foundation Trust,
All Rights Reserved 2015. Document for issue as handout.
Unique Identifier: NOE56(15). Review date: November 2017
1
During the procedure
The procedure does not involve
the use of a general or local
anaesthetic, and you do not
need to fast.
Botulinum toxin is not a
suitable treatment if you are
pregnant, breast feeding or
“trying” for a baby.
If you are taking Warfarin, (an
anti coagulant) you may not
be suitable for treatment with
botulinum toxin.
The procedure is performed in the
clinic and takes approximately
five to ten minutes.
The initial set of injections will
be given by the Consultant
Neurologist. Once the response
to the injections is apparent
the doctor may refer you to the
Dystonia Nurse Practitioner for
further injections.
You will be seated in a chair
for the injections to your neck.
The doctor / nurse will examine
your neck and select the
appropriate muscles to inject
with botulinum toxin.
The exact dose may vary
dependent on your response to
previous treatments.
After four to seven days the
injection will usually start to
work causing a temporary
weakness in the neck muscles,
this should help to relieve pain
and neck spasm.
2
After the procedure
When can you leave hospital?
After the procedure you will be
able to return home, back to
normal activities.
When can you resume normal
activities including work? Most people who have had this
procedure can resume normal
working activities immediately
after their injections.
Special measures you need to
take after the procedure:
None, but try to avoid touching or rubbing the site that has
been treated.
Follow up:
Before you leave the clinic you
will be given details of your
next appointment. This is
usually in 3-4 months time. If
you have any tests performed
your consultant will inform your
Doctor of the results. These
results will be discussed on your
return visit.
You will be given the contact
details of the dystonia nurse
practitioner in case you have
any problems, questions or
concerns regarding your
treatment.
If you are unable to make
your next appointment for
any reason please contact the
dystonia nurse practitioner to
make alternative arrangements.
Alternative procedures
that are available
Occasionally medication is
prescribed to treat cervical
dystonia. In general, the
medication is only partially
effective and can be associated
with side effects. For most
patients botulinum toxin is
the best option initially. Your
doctor will discuss this with you.
© G15110603W. Design Services, Salford Royal NHS Foundation Trust,
All Rights Reserved 2015. Document for issue as handout.
Unique Identifier: NOE56(15). Review date: November 2017
3
Possible side effects of the botulinum toxin injections
Following the procedure, the
majority of individuals with
cervical dystonia experience
relief from their symptoms.
Side effects are relatively rare
and are almost always temporary,
usually wearing off within a few
days or weeks. Potential side
effects include the following:
l Pain at the injection site.
l Occasionally bruising may
develop around the injection
site.
l Sometimes patients may
experience swallowing
problems due to the muscles
being weakened in the area of
the throat. If this occurs eating
a soft diet until the muscles
are stronger may be necessary.
l Temporary neck weakness.
l Botulinum toxin contains
human albumin which comes
from human blood. As
with any medicine which is
created from human blood
there is a possibility of
passing on infections.
4
To reduce this risk, blood
donors are chosen very
carefully. Furthermore,
botulinum toxin is made in a
way that should remove or
destroy viruses. This may be
of importance to Jehovah’s
witness’ when considering
treatment.
l On rare occasion’s flu like
symptoms, headaches, fever
and feeling tired may occur.
l With repeated injections,
occasionally the muscles of
the neck can become thinner
and weaker, particularly
if the injections are
administered too soon.
l Occasionally patients can
develop antibodies against
the toxin. Antibody
formation is more likely to
form with high doses of
botulinum toxin and if it is
administered before a 12
week interval. If your body
builds up antibodies to the
botulinum toxin it will no
longer work.
Information and support
The team
There are leaflets about the
condition and botulinum toxin
available at your appointment
and in the waiting area.
If you have any questions or
anxieties, please feel free to
discuss them with the consultant
or dystonia nurse practitioner.
Further information is also
available from the:
Dystonia Society
Telephone:
Dr Silverdale, Dr Kellett,
Diane Ashton, Dr Dick
0845 458 6322
Website:
Your Consultant Neurologist is:
www.dystonia.org.uk
There is a local branch of the
dystonia society. This gives you
an ideal opportunity to meet
other people with dystonia. For details you can contact:
Chris Smith
Telephone:
0845 899 7131
Your Dystonia Nurse Practitioner is:
Diane Ashton
Contact details:
0161 206 2562
[email protected]
© G15110603W. Design Services, Salford Royal NHS Foundation Trust,
All Rights Reserved 2015. Document for issue as handout.
Unique Identifier: NOE56(15). Review date: November 2017
5
© G15110603W. Design Services
Salford Royal NHS Foundation Trust
All Rights Reserved 2015
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Unique Identifier: NOE56(15)
Review Date: November 2017
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Equality Act we will make
‘reasonable adjustments’
to enable individuals with
disabilities, to access this
treatment / service.
Email: [email protected]
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