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Human Motor Control Section, Medical Neurology Branch (Drs. Cole, Cohen, Grill, and Lou) and Office of the Clinical Director (Drs. Karp and Hallett), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD.
We treated focal hand dystonia in 53 patients with botulinum toxin injections for up to 6 years. Eighty-one percent of the patients improved with at least one injection session. Sixty-five percent of the injections produced transient weakness. We followed 37 of the patients for at least 2 years from the start of treatment, 24 of whom discontinued treatment because of inadequate response, loss of response, inaccessibility of a treatment provider, or the expense of the toxin. Women, who had a greater extent and longer duration of benefit than men, were more likely to continue treatment. The mean interval between injection sessions was 6 months. In most patients, we injected the toxin into the same combination of muscles at each session. The dose of toxin generally fluctuated within a range of 20 units. Side effects were mild and transient and unrelated to the long-term use of botulinum toxin. Botulinum toxin injection is safe and effective for the long-term management of focal hand dystonia.
Address correspondence and reprint requests to Dr. Barbara Illowsky Karp, OCD, NINDS, NIH, Building 10, Rm 5N-226, Bethesda, MD 20892.
Received March 29, 1993. Accepted for publication in final form July 15, 1993.
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