The role of EMG guidance in botulinum toxin (BTX) therapy

Nowadays, botulinum toxin (BTX) is the treatment of choice for most patients with focal dystonia. Guidelines regarding technique and dosage vary considerably. One issue remains the role of EMG in refining treatment outcome. Basically all studies on blepharospasm were conducted without EMG. More than 60% of patients with cervical dystonia consider BTX even after years of regular injection sessions every 3 to 4 months as a valuable treatment and ask for reinjections. The impact of EMG guidance has been only rarely assessed. The effectiveness of BTX with EMG control in writer's cramp and in spasmodic dysphonia has been demonstrated in a number of studies. Refinement of therapy remains a challenge in writer's cramp and other occupational dystonias, jaw opening dystonia and anterocollis. EMG guidance may be helpful, probably even a prerequisite in these indications. The role of EMG guidance in the major indications such as uncomplicated cervical dystonia and spasticity to improve outcome, to minimise side effects and to save toxin, has not yet been clarified.     «

Nowadays, botulinum toxin (BTX) is the treatment of choice for most patients with focal dystonia. Guidelines regarding technique and dosage vary considerably. One issue remains the role of EMG in refining treatment outcome. Basically all studies on blepharospasm were conducted without EMG. More than 60% of patients with cervical dystonia consider BTX even after years of regular injection sessions every 3 to 4 months as a valuable treatment and ask for reinjections. The impact of EMG guidance has...     »