How Do I Treat Cervical Dystonia With Botulinum Toxin by Using Ultrasound?

The therapy of cervical dystonia with botulinum toxin was established in the late 1980s. It is accepted as the therapy of choice, and the good results have been confirmed in many studies. In the last decade, tremendous developments have influenced our clinical work, and it seems that this will also influence the clinical outcome positively. Such developments include: first, the more anatomically based view and classification of cervical dystonia; second, the use of sonography to visualize the muscles and inject more precisely; and, third, the awareness that the action of the muscles involved is not physiological, but dysfunctional. Now it is time to combine the classification, the use of sonography and the new pathofunctional approach, to obtain the best clinical results.