Botulinum a toxin for spasmodic torticollis: Multiple vs single injection points per muscle

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Abstract
Eighty‐six injections in 49 patients with adult onset spasmodic torticollis were evaluated for efficacy with respect to single point per muscle versus multiple point per muscle injection techniques. Parameters of the syndrome assessed were pain, posture deformity, range of cervical motion, disfigurement, cervical muscle hypertrophy, activity limitation, and degree of involuntary movement. The multiple point per muscle injection strategy appeared superior to the single injection per muscle technique with respect to pain (p < 0.002, chi‐square), posture deformity (p < 0.001), range of motion (p < 0.001), and improvement in activity endurance (p < 0.001). No significant differences were noted with respect to cervical muscle hypertrophy or degree of involuntary movements, although the injections were considered beneficial in both groups to these syndrome components.