Idiopathic cervical dystonia (spasmodic torticollis)

Active Ingredient: Botulinum toxin type A

Indication for Botulinum toxin type A

Population group: only adults (18 years old or older)
Therapeutic intent: Curative procedure

For this indication, competent medicine agencies globally authorize below treatments:

25-200 Units depending on each individual patient


Dosage regimens

Intramuscular, between 25 international units botulinum toxin type A and 200 international units botulinum toxin type A, once every 10 weeks.

Detailed description

Recommended needle: A 25, 27 or 30 gauge/0.50-0.30 mm needle may be used for superficial muscles, and a 22 gauge needle may be used for deeper musculature.

Administrative guidance: The treatment of cervical dystonia typically may include injection of botulinum toxin type A into the sternocleidomastoid, levator scapulae, scalene, splenius capitis, semispinalis, longissimus and/or the trapezius muscle(s). This list is not exhaustive as any of the muscles responsible for controlling head position may be involved and therefore require treatment. The muscle mass and the degree of hypertrophy are factors to be taken into consideration when selecting the appropriate dose. Muscle activation patterns can change spontaneously in cervical dystonia without a change in the clinical presentation of dystonia.

In case of any difficulty in isolating the individual muscles, injections should be made under electromyographic assistance.

Multiple injection sites allow botulinum toxin type A to have more uniform contact with the innervation areas of the dystonic muscle and are especially useful in larger muscles. The optimal number of injection sites is dependent upon the size of the muscle to be chemically denervated.

Recommended dose: Dosing must be tailored to the individual patient based on the patient’s head and neck position, location of pain, muscle hypertrophy, patient’s body weight, and patient response.

Initial dosing in a naïve patient should begin at the lowest effective dose.

To minimise the incidence of dysphagia, the sternomastoid should not be injected bilaterally.

The following doses are recommended:

Type I
Head rotated toward
side of shoulder
Sternomastoid50-100 Units; at least 2 sites
Levator scapulae50 Units; 1-2 sites
Scalene25-50 Units; 1-2 sites
Splenius capitis25-75 Units; 1-3 sites
Trapezius25-100 Units; 1-8 sites
Type II
Head rotation only
Sternomastoid25-100 Units; at least 2 sites if >25 Units given
Type III
Head tilted toward
side of shoulder
Sternomastoid25-100 Units at posterior border; at least 2 sites if >25 Units given
Levator scapulae25-100 Units; at least 2 sites
Scalene25-75 Units; at least 2 sites
Trapezius25-100 Units; 1-8 sites
Type IV
Bilateral posterior
cervical muscle
spasm with elevation
of the face
Splenius capitis and cervicis50-200 Units; 2-8 sites, treat bilaterally(This is the total dose and not the dose for each side of the neck)

Maximum dose:

No more than 50 Units should be given at any one injection site.

No more than 100 Units should be given to the sternomastoid.

No more than 200 Units in total should be injected for the first course of therapy, with adjustments made in subsequent courses dependent on the initial response, up to a maximum total dose of 300 Units.

Additional information: Treatment intervals of less than 10 weeks are not recommended.

Dosage considerations

No more than 50 Units should be given at any one injection site.

No more than 100 Units should be given to the sternomastoid.

Active ingredient

Botulinum toxin type A

Botulinum toxin type A is a protein complex derived from Clostridium botulinum. The protein consists of type A neurotoxin and several other proteins. Under physiological conditions it is presumed that the complex dissociates and releases the pure neurotoxin. Intramuscular injection of the neurotoxin complex blocks cholinergic transport at the neuromuscular junction by preventing the release of acetylcholine. The nerve endings of the neuromuscular junction no longer respond to nerve impulses and secretion of the chemotransmitter is prevented (chemical denervation).

Read more about Botulinum toxin type A

Related medicines

Develop a tailored medication plan for your case, considering factors such as age, gender, and health history

Ask the Reasoner

Liability Disclaimer : RxReasoner has utilized reasonable care in providing content and services that are accurate, complete and up to date. However, RxReasoner does not accept any responsibility or liability about it. The content and services of RxReasoner are for informational purposes only and they are not intended to be a substitute for the knowledge, expertise, skill, and judgment of physicians, pharmacists, nurses, or other healthcare professionals involved in patient care. RxReasoner offers no medical advice. Users are responsible for the use of the provided content. A shown indication or treatment should not be construed to indicate that the medication is safe, appropriate, or effective in any given patient or under any particular circumstances. The absence of an indication or treatment should not roule out the existence of other appropriate medications. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition or medicament. RxReasoner is not liable for any damages allegedly sustained arising out of the use of its content and services.