In Reply.—Drs Sanders and Massey correctly stress the importance of being cautious when administering botulinum toxin. The authors were aware of the electromyographic techniques that demonstrate botulinum toxin spreading and affecting remote muscles, at least on electromyographic studies. However, the amounts of toxin that were used in these studies were two and three times the amounts used in our patients. Generally speaking, the treatment of torticollis requires several hundred units of Clostridium botulinum toxin type A (Oculinum), and this currently is, to our knowledge, not an approved use of this investigational drug. Treatment in the cervical region certainly could cause vocal cord paresis. However, we intentionally avoided treatment below the ramus of the mandible in our series.
The dose concentration of toxin that has been given is considered sufficiently low so as to not elicit an immune response.1 Additionally, histopathologic studies of injected extraocular muscles show no
BIGLAN AW, MAY M, BOWERS RA. Management of Facial Spasm With Clostridium botulinum Toxin-Reply. Arch Otolaryngol Head Neck Surg. 1989;115(7):882. doi:10.1001/archotol.1989.01860310120038
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: