The Effect of Low Dose OnabotulinumtoxinA on Cervical Dystonia in Hypermobile Ehlers-Danlos Syndrome

Tina J Wang; Antonio Stecco; Khashayar Dashtipour

doi:10.5334/tohm.647

The Effect of Low Dose OnabotulinumtoxinA on Cervical Dystonia in Hypermobile Ehlers-Danlos Syndrome

Tremor Other Hyperkinet Mov (N Y). 2021 Oct 25:11:42. doi: 10.5334/tohm.647. eCollection 2021.

Authors

Tina J Wang¹, Antonio Stecco², Khashayar Dashtipour³

Affiliations

¹ Loma Linda University School of Medicine, Department of Physical Medicine & Rehabilitation, US.
² New York University School of Medicine, Department of Rehabilitation, US.
³ Loma Linda University School of Medicine, Department of Neurology, US.

Abstract

Background: Many patients with hypermobile Ehlers-Danlos Syndrome (EDS) suffer from cervical dystonia. Intramuscular injection of botulinum toxin may exacerbate myeloradiculopathy or atlantoaxial subluxation in this patient population.

Case: Three patients with hypermobile EDS underwent low-dose OnabotulinumtoxinA injections for cervical dystonia into myofascial sites selected using Fascial Manipulation diagnostic sequencing technique. All patients improved in clinical symptoms without complications.

Results: Patients clinically improved on the TWSTRS by 16 points with demonstrated changes in deep fascia thickness decrease of 0.28 mm.

Discussion: Low-dose OnabotulinumtoxinA injections into carefully selected sites is a safe and effective treatment in hypermobile EDS patients suffering from cervical dystonia.

Keywords: Ehlers-Danlos Syndrome; OnabotulinumtoxinA; cervical dystonia; fascia; hypermobility; myofascial; sonoelastography.

Publication types

Case Reports

MeSH terms

Botulinum Toxins, Type A* / therapeutic use
Ehlers-Danlos Syndrome* / complications
Ehlers-Danlos Syndrome* / drug therapy
Humans
Injections, Intramuscular
Torticollis* / drug therapy
Treatment Outcome

Substances

Botulinum Toxins, Type A

Grants and funding

Dr. Wang and Dr. Stecco do not have financial disclosures or conflicts of interests. Dr. Khashayar Dashtipour has received honoraria or payments for consulting, advisory services, or speaking over the past 12 months from AbbVie, Acadia, Adamas, Allergan, Amneal, Ipsen, Neurocrine Biosciences, Kyowa Kirin, Supernus, Sunovion, and Teva. Dr. Dashtipour’s institution has received research support over the past 12 months from AbbVie, Ipsen, and Supernus.