Botox for cervical dystonia: Effectiveness and more

Key takeaways

• Botox (onabotulinumtoxinA) is an injection prescribed to treat cervical dystonia in adults.
• Your doctor will typically start by prescribing a low dose, such as 100 units every 3 months. Depending on how well Botox works for you, they may increase your dose. Sometimes, up to 50 units per injection site may be given.
• In a study, Botox seemed to be most effective at relieving cervical dystonia 6 weeks after injection. The drug’s effects wore off after about 3 months.

Botox is a brand-name biologic that belongs to a drug class called neurotoxins. The drug is not available in a biosimilar version. A biosimilar is a medication that is similar to a biologic drug (known as the reference drug). Biosimilars are considered to be as safe and effective as the reference drug.

Note: The Food and Drug Administration (FDA) has approved Botox for treating certain medical conditions, including cervical dystonia. Another version of Botox, called Botox Cosmetic, is FDA approved for certain cosmetic procedures.

Although both Botox and Botox Cosmetic contain onabotulinumtoxinA as the active ingredient, these drugs are not meant to be used interchangeably. Also, it’s not recommended to use Botox for a condition that the FDA has not approved. Using Botox for a condition that is not approved by the FDA may cause serious side effects.

The use of Botox for cervical dystonia may cause mild or serious side effects. Botox is approved to treat other conditions as well. It’s important to note that side effects of Botox may differ depending on the condition it’s used to treat.

The following lists include some of the main Botox side effects that may occur while using the drug for cervical dystonia. To learn about other possible side effects of the drug, talk with your doctor or pharmacist. You can also refer to Botox’s prescribing information.

Note: After the FDA approves a drug, it tracks and reviews side effects of the medication. Sharing your experience helps make medications safer for everyone by giving doctors and researchers more information about how the drug works in real life. If you develop a side effect while receiving Botox and want to tell the FDA about it, visit MedWatch or call 800-332-1088.

Mild side effects

Like other medications, Botox injections can cause mild side effects. These side effects may be temporary, lasting a few days or weeks. But if they last for a longer time, bother you, or become severe, it’s important to talk with your doctor or pharmacist.

Mild side effects of Botox injections for cervical dystonia can include:

• back pain
• cough
• dysphagia (difficulty swallowing)
• flu-like symptoms, such as fever, muscle pain, and nausea
• headache
• neck pain
• rhinitis (inflammation in the nose)
• upper respiratory infections, such as the common cold
• muscle weakness or loss of strength
• dizziness
• vision problems

Note: After receiving Botox injections, watch for muscle weakness or loss of strength, dizziness, or vision problems. These side effects can occur hours, days, or weeks after receiving Botox treatment. If you experience them, avoid operating a car or machinery or participating in dangerous activities. Talk with your doctor so that they can evaluate your symptoms.

Serious side effects

Though rare, Botox injections can cause serious side effects. Call your doctor right away if you develop serious side effects while using Botox. If the side effects seem life threatening or you think you’re having a medical emergency, call 911 or your local emergency number immediately.

Serious side effects from Botox injections can include:

• allergic reaction
• risk of toxin effects spreading, which potentially could cause life threatening breathing or swallowing difficulties

Botox has a boxed warning about the risk of the toxin’s effects spreading. For more information, see the “Before receiving Botox” section.

A clinical trial showed the effectiveness of Botox injections as a treatment for cervical dystonia. This is a movement disorder that causes involuntary muscle spasms in the neck.

In this study, people received injections of either Botox or a placebo (treatment with no active drug ingredient) into the affected muscles. The researchers wanted to see whether Botox was better than the placebo at improving people’s scores on the Cervical Dystonia Severity Scale. A high score on this 54-point scale indicates more severe problems with head position.

The researchers found that people who received Botox injections had more significant decreases in their scores than people who received placebo injections.

Guidelines from the American Academy of Neurology recommend Botox as a first-line treatment for cervical dystonia. This means that Botox would be the first treatment a doctor prescribes for the condition.

The FDA has approved Botox to treat cervical dystonia, a movement disorder that causes involuntary muscle spasms in the neck.

Dosage

The dosage of Botox for treating cervical dystonia will depend on:

• the severity of your condition
• the muscle or muscles affected
• the level of pain you have due to your condition

Your doctor will determine the total amount of Botox that’s right for you. This will be divided and administered in multiple injections for the affected muscle or muscles.

The average Botox dose for cervical dystonia in clinical trials was 236 units, given as multiple injections to affected muscles. Usually, your doctor will start you on a low dose, such as 100 units. Based on how your body responds, they may increase your dosage. Depending on the muscles involved, your doctor may administer up to 50 units of Botox into each injection site.

Note: In addition to treating cervical dystonia, Botox has other FDA-approved uses. Botox’s dosage differs for its other uses. For more information, talk with your doctor.

How Botox is given

Botox comes as a liquid solution. To treat cervical dystonia, you will receive the drug as intramuscular injections into your neck muscles. Only a healthcare professional can give the injections, which you’ll receive during treatment sessions.

How often it’s given

Your doctor will advise you on how often you’ll need to receive Botox injections for your cervical dystonia. Based on the findings of clinical trials, they may start with injections every 3 months. They may then make adjustments based on any side effects you have and how well the drug eases your symptoms.

In a clinical trial, people who received Botox for cervical dystonia noted that the effects seemed to wear off about 3 months after their previous dose. Botox treatment appeared to be most effective at relieving cervical dystonia symptoms 6 weeks after the injection.

How much Botox costs varies according to several factors. These can include your prescribed treatment regimen, your insurance plan, and where you receive your injections.

To find out what you might pay for Botox, talk with your doctor, pharmacist, or insurance provider if you have coverage.

Botox is approved by the FDA to treat cervical dystonia in adults.

The way Botox works

Botox is a type of drug called a neurotoxin. It works by stopping nerves from functioning.

Your nerves communicate with other parts of your body by using a neurotransmitter called acetylcholine. (Neurotransmitters are chemical messengers.) Botox works by preventing nerves from releasing acetylcholine. As a result, your nerves can’t send messages to muscles telling them to contract or spasm.

With cervical dystonia, Botox prevents nerves from causing muscle contractions or spasms in your neck.

Over time, the effects of Botox injections wear off. This is because your nerves develop new endings that can begin releasing acetylcholine again.

How quickly does Botox work for cervical dystonia?

In a clinical trial, people who received Botox injections for cervical dystonia began noticing improvement in their condition within the first 2 weeks of receiving a dose. Botox seemed to be most effective at easing symptoms of cervical dystonia 6 weeks after people received the injections. Here are some frequently asked questions about using Botox to treat cervical dystonia.

Can Botox make cervical dystonia worse?

It’s unlikely. In a clinical trial, worsening cervical dystonia wasn’t reported as a side effect. However, between Botox injections, you may notice cervical dystonia symptoms coming back, especially as more time passes since your last dose. In the trial, most people who received Botox injections reported that their cervical dystonia returned to “pretreatment” status about 3 months after their last dose. Botox treatment seemed to be most effective at easing symptoms of cervical dystonia 6 weeks after people received the injections. If Botox injections don’t seem to be easing your cervical dystonia symptoms, talk with your doctor. They’ll determine the best treatment for your condition.

If I use Botox for a long time, could it become less effective?

It’s possible. If you use Botox for a long time, your immune system might become so used to recognizing Botox that it develops antibodies to fight it. (Antibodies are blood proteins made in response to a specific substance in order to counteract it.) As the antibodies learn to fight Botox, the drug may become less effective at easing your cervical dystonia symptoms. This means that you’re developing an immunity to Botox. It isn’t clear why some people’s bodies create the antibodies. Receiving Botox more frequently or at higher doses than usual may make your body more likely to create antibodies. Your doctor will try to reduce your risk of immunity to Botox. They’ll do this by prescribing the lowest dose to treat your symptoms and waiting as long as possible between injections. But if Botox injections don’t seem to be easing your symptoms of cervical dystonia, talk with your doctor. They can adjust your treatment plan as needed. Cervical dystonia is a movement disorder that causes involuntary muscle spasms in your neck. It’s also referred to as spasmodic torticollis. The spasms create repetitive and uncomfortable movements in your head and neck. This results in atypical head positioning, which can cause pain in your neck. Symptoms of cervical dystonia can include neck twisting. Symptoms can also include the head and neck pulling backward, forward, or sideways.

The goal of Botox for cervical dystonia

The FDA has approved Botox to treat cervical dystonia in adults. The goal of treatment is to ease atypical head positions and neck pain.

Before you use Botox, there’s some important information to keep in mind. The drug may not be a safe option for you if you have certain medical conditions or other factors that affect your health. These are described in the following text.

Boxed warning: Risk of toxin effects spreading

Botox has a boxed warning. This is the most serious warning from the FDA. A boxed warning alerts doctors and patients about drug effects that may be dangerous.

Sometimes, Botox may spread from where it’s injected to other parts of your body. This can result in botulism, a serious condition that may cause symptoms such as:

• lack of energy
• difficulty breathing
• difficulty speaking
• difficulty swallowing
• drooping eyelids
• double vision
• hoarse voice
• loss of control over your bladder
• muscle weakness

Botulism can occur hours, days, or weeks after a Botox injection. It’s important to talk with your doctor if you experience any of these symptoms while using Botox.

Though rare, difficulty breathing or swallowing can be life threatening. People who already have difficulty breathing or swallowing may be at higher risk of these problems.

Call your doctor right away if you experience problems with breathing or swallowing after a Botox injection. If you feel that your symptoms are life threatening, call 911 or your local emergency number.

Other warnings

In addition to a boxed warning, Botox has other warnings.

If any of the following medical conditions or other health factors apply to you, talk with your doctor before receiving Botox:

• if you have a neuromuscular disorder, such as amyotrophic lateral sclerosis (ALS) or myasthenia gravis
• if you have an infection in the area where you would receive Botox injections, such as the neck
• if you have an upcoming surgery
• if you’re pregnant or breastfeeding
• if you’ve had an allergic reaction to Botox or any of its ingredients

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.