Botulinum toxin therapy for spasmodic torticollis. Medical and non-medical adjunct treatment

Background. Spasmodic torticollis patients were investigated with respect to the number of adjunct treatments used before and after the introduction of botulinum toxin therapy (Btx). The study was designed in a similar way to an earlier investigation by Birner et al. (Nervenarzt 70:903-908, 1999). Material and methods. A total of 247 patients with idiopathic spasmodic torticollis were assessed at three time points for the diagnosis: before 1988 (n=63), between 1989 and 1998 (n=107) and after 1999 (n=77). Results. Independent of the year of diagnosis patients underwent a mean of 14.3 different treatments. In addition to Btx most of the patients were subjected to massage, physiotherapy, medication and a large number of non-medical treatments including praying. No associations to clinical or personal variables were found. Those patients with emotional disorders prior to onset of dystonia displayed a higher rate of medical and non-medical treatments in addition to Btx. Conclusions. The results confirmed those found by Birner et al.. In order to enhance compliance patients should undergo psycho-education with respect to illness behaviour and specific history taking with respect to emotional disorders prior to dystonia.