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Treatment of dystonic clenched fist with botulinum toxin

Authors

  • Carla Cordivari MD,

    1. Department of Clinical Neurophysiology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
    2. Reta Lila Weston Institute of Neurological Studies, University College of London, United Kingdom
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  • V. Peter Misra MD, FRCP,

    1. Department of Clinical Neurophysiology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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  • Santiago Catania MRCP,

    1. Department of Clinical Neurophysiology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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  • Andrew J. Lees MD, FRCP

    Corresponding author
    1. Reta Lila Weston Institute of Neurological Studies, University College of London, United Kingdom
    • Reta Lila Weston Institute of Neurological Studies, Windeyer Building, 46 Cleveland Street, University College of London W1T 4JF, UK

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  • A videotape accompanies this article.

Abstract

Fourteen patients with “dystonic clenched fist” (three with Corticobasal Ganglionic Degeneration, seven with Parkinson's disease, and four with Dystonic-Complex Regional Pain Syndrome) were treated with botulinum toxin A (BTXA, Dysport®). The muscles involved were identified by the hand posture and EMG activity recorded at rest and during active and passive flexion/extension movements of the finger and wrist. EMG was useful in distinguishing between muscle contraction and underlying contractures and to determine the dosage of BTX. All patients had some degree of flexion at the proximal metacarpophalangeal joints and required injections into the lumbricals. The response in patients depended on the severity of the deformity and the degree of contracture. All patients had significant benefit to pain, with accompanying muscle relaxation, and palmar infection, when present, was eradicated. Four patients with Parkinson's disease and one patient with Dystonia-Complex Regional Pain Syndrome obtained functional benefit. © 2001 Movement Disorder Society.

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