Botulinum toxin injections for Cervical Dystonia_Dec 2017

Danish Bhatti MD FAAN
/ danish-bhatti

[@premkumarsinha3672]

great demo of your technique, i find it one of the best lecture

[@DanishBhatti_MD]

Thank you. Much appreciated.

[@manonvanderburgt76]

Dear Danish Bhatti, I was looking for more info about dystonia torticollis on the internet. I came across your video and I find it very informative. Certainly how the neurologists should find the right dyagnosis and muscles to choose the right treatment. respect! I was in a car accident in 2001 with whiplash. From 2013 I started having spasm complaints. Dyagnosis Dystonia torticollis in the Netherlands. Now I have had the 2nd session of botox injections in Spain, where I live. The first time I did not experience any improvement. The drugs diazepam didn't work either. Now again about 10 botox injections in the neck and shoulder and also 10 mg diazepam every evening. I will see if there will be improvement. I am currently not able to function well such as walking, cycling, driving, working etc. I hope to get back to my normal life soon. I believe in Botox! What more could I do to normalize my life as a 48 year old woman?? Thank you so much. And good luck with your patients.

[@DanishBhatti_MD]

very sorry to hear that. Botox response in good hand is 70-80%. so failure is not uncommon. Next step in treatment is likely Deep Brain Stimulation Surgery. you can check out some of my videos on it and others on internet. try with couple of different injectors as we all are trained to select muscles differently.

[@jminichcastro]

Excellent informational video.

[@DanishBhatti_MD]

Thank you. I appreciate your feedback.

[@tejujagtap3531]

hello sir, i m also suffering cervical dystonia last 6yrs , lots of dr. give medications but it not cure ....i m 31yr old grl , there is any hope to cure or wht typ of treatmnt should be proper for it...plz rply .Dr

[@DanishBhatti_MD]

botox (botulinum toxin injections) is the treatment of choice for this.

[@carlosvargas4141]

buena presentacion

[@deniseball6137]

I have watched your video over and over trying to see what muscles to inject. I think you are an awesome Dr. and know your stuff. Too bad you couldn't be closer to be my doctor. Anyway I was diagnosed with torticollis 20 yrs ago a little tremor. was in remission for 20 yrs but now has come back with head twisting to left and down to shoulder. Could you tell me what muscles you would inject and what side? I am seeing pain management had first botox but nothing accomplished. He doesn' t use that machine that you use. I am afraid there just experimenting on me. Thank you so much

[@DanishBhatti_MD]

sorry to hear that. no easy way to recommend muscles without seeing a video of the patient.

[@mahendrapratapsingh3415]

Correct sir

[@kanchangtk2013]

Good morning sir. I’am a orthopaedic surgeon . I have seen few cases of cervical dystonia in my practice. Thank you so much sir , your video is really informative. Kindly let me know sir if you are conducting any workshop in India. Thank you sir

[@DanishBhatti_MD]

I have run an online Minifellowship in movement disorders for last 5 years but have not done any workshops in India. I have done one in Qatar.

[@kanchangtk2013]

@@DanishBhatti_MD thank you so much sir for your response. In near future if you ever visited India or started mini fellowship courses in India, we will be very fortunate to learn from you sir.

[@HassanShahid915_]

Sir kya cervical dystonia ke symptoms har case me worsen hote he rehte hen? Ya kuch logo me mild neck turning tak he reh sakte?

[@ManshiKD]

Very informative video. Sir, I am currently pursuing Neurology Residency from India (AIIMS). I read about your 6 months online fellowship. Kindly let me know if you also conduct any workshops like the above or any training where we could probably get a hands on experience. I am keenly interested to learn the techniques for Botulinum injections in MD. I look forward to your reply. Thank You.

[@DanishBhatti_MD]

thanks for reaching out. I do run an online fellowship annually for last 5 years and have trained 3 neurologists from India so far. unfortunately I have not been to India yet and have not done any workshop there though I have done them in Qatar and Pakistan. there may be opportunity to do rotations in US if you search on internet. they won't let you inject but at least show you how to do it.

[@aileenduncan1317]

I've had this treatment 4 times over the last 12 months. I find the injections very painful, the side effects of the treatment, and the trade off of one type of discomfort for a different one of the same degree or worse is, I'm beginning to think, not worth it. Please don't be put off though. It's worth a try if you're in as much pain and discomfort as I am. I opted for this instead of drugs and will discuss other options with my GP soon.

[@DanishBhatti_MD]

pain also correlates to size of the needle (thickness measured in G.- gauge). higher number (thinner needles) are more comfortable. I typically use 27 G. which is 1/4th the thickness of 18 G which is often used by some injectors outside of US. there was also a note somewhere that using distilled water (instead of normal saline) to reconstitute Botox makes the injection more painful.

[@aileenduncan1317]

@@DanishBhatti_MD thanks. I'll bare this in mind.

[@shravankumar7256]

Injection or medicine ke Alawa or koi treatment he kya cervical dystonia ka.

[@DanishBhatti_MD]

Deep Brain Stimulation Surgery.

[@truptikansara2232]

Sir mere Bhai ko servical dystonia hai bottex injection diya 4 month acha rahta hai fir vapas neck halchal karti hai koi upai ho to batavo hum amdavad ke rahne Vale hai

[@DanishBhatti_MD]

this is expected. botox sirf 3-4 maheney chalta hey aur bar bar dena parta hey. koi nuksan nahin hey but expensive for many people. US mein insurance cover karti hey is liye zayada masla nahin. Gap zayada karney ka nuksan nahin. Can try every 6 months.

[@bossbaskar865]

I am baskar,doctors tell me i have a survical distrinio,and they told,take botox injunction, i have one questions sir,this typed of cases after take botox injunction get normal conditions sir

[@DanishBhatti_MD]

Botox blocks the brain signals coming to the neck and improves symptoms. It is not a cure. The benefits last for 2-4 months and then start going away and injection has to be repeated. However it can be safely repeated for 20+ years and many patients think its better then taking a pill 2-3 times a day and cost is probably about the same when spread over 3-4 months.

[@Ro-ud6sy]

Writer's cramp dystonia का treatment है क्या जनाब From ajmer sharif India

[@DanishBhatti_MD]

I believe I have a video of it on the channel. try searching. will try to add more.

[@namitadas3807]

Sir, my mother has been diagnosed with Cervical Dystonia ( head bending backward). On 10 th August this year, she received her first botox injection but there is no sign of improvement infact it seems to deteriorate further. She is also taking medicines. Looking forward to your precious advice.

[@DanishBhatti_MD]

not sure about it. Poor response or worsening either means that the diagnosis was not correct or that the injection plan was opposite of what needs to be injected. I have seen both issues.

[@shravankumar7256]

Sir Agr botox injection nai le agr surgery krwaye to chl jata he na

[@DanishBhatti_MD]

there are many types of surgeries for this. I only recommend Deep Brain Stimulation Surgery.

[@sandhyakaishal1046]

Sir good evening,my husband has faced facial dystonia.very hard time.from last January.plz guide us.he has taken botox injections in March 2020,25 gm

[@DanishBhatti_MD]

I think Botulinum toxin injections are the best approach. Sometimes it takes 2-3 visits to fine tune the right injection plan.

[@suchetamathakari5937]

Sir hello. I am suffering from cervical dystonia since last 1 month. I took my first shot 15 days ago. Very less progress. Sir Do you visit India?

[@DanishBhatti_MD]

not yet. but India is such a big country. even If I did, it might be to couple of cities only. there are many excellent injectors in India. I think couple of them in Delhi.

[@suchetamathakari5937]

Sir pls reply to me. Can botox be repeated after 6 weeks in cervical dystonia

[@DanishBhatti_MD]

ideally we should wait at least 8 weeks before reinfection to lower the risk of developing resistance to it (immune resistance). however that number (8 weeks) was arbitrarily decided by some experts and their is no study to support it and some experts do inject before 8 weeks without much trouble.

[@bhanugoud5226]

Sir when I'm blinking hard my right eye lower bottom lid twitching.. what is my problem sir

[@DanishBhatti_MD]

likely nothing. eyelid myoclonus is common and mostly physiological. do check for low calcium or electrolytes on next blood test.

[@fastlife4329]

Meri mother cervical dystonia patient hn 3month tk thek rehti hn ab 6 month hogye hen yahan pak me botax availble q nhi hai.. Din rat pain me hen islamabad doctor farheen ki patient hn but islamabad me botax nhi mil rhy

[@DanishBhatti_MD]

Farheen is really good. she did train with me. you can consider the non-FDA approved Korean botox if necessary. less reliable but might work.

[@thelight7428]

How much units we can inject?

[@DanishBhatti_MD]

typical range for Cervical dystonia is 100-400 units of Botox (different for other products) with average around 200-250. Up to 900 Units have been used by experts ( I have gone up to 700 units). Again units are different for each product and these numbers only pertain to Botox.

[@TouseefAhmed-tr2cg]

Sir I have cirvical dystonia from last two years and taking treatment like Botox but feel no improvement. Can you suggest me a doctor in Pakistan for the better treatment or are you available in Pakistan or not?

[@DanishBhatti_MD]

I am not available in Pakistan. In pakistan good options would be Movement Disorders Clinic at Shifa International hospital in Islamabad and 2nd option would be Movement Disorders Clinic at South City hospital karachi.

[@ayerseno2532]

Eve sir . I have a laterocollis. How can I contact u?

[@DanishBhatti_MD]

you can find me on LinkedIn. I unfortunately am not able to do online consultation. I recommend consulting someone locally.

[@hddh9817]

Hi I need your email Thanks