We have been studying the efficacy of local injections of botulinum toxin for the treatment of different types of focal dystonias. Botulinum toxin injected in small doses directly in muscle, binds to the neuromuscular junction and inactivates it for approximately three months. We have also been using botulinum toxin to study the physiology of focal dystonias. Studies of the utility of botulinum toxin are being carried out in writer's cramp (and its variants such as pianist's cramp) in open-label and double-blind trials. Treatment appears effective at least in the short-term. Longer follow-up on our patients is now being analyzed. In our subgroup of patients with musician's cramp, most of the patients eventually decide the treatment is insufficient for their needs. We have begun a trial of botulinum toxin in spasmodic torticollis with the purpose of analyzing the dysphagia that some of these patients have following injection. We have begun a phase l trial of botulinum toxin type F to see if this will benefit patients who have developed antibodies to type A. In the first few patients, it appears successful.
