title: Treatment of dystonic clenched fist with botulinum toxin.
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.
authors.affiliation: Department of Clinical Neurophysiology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors.forename: C
authors.initials: C
authors.lastname: Cordivari
authors.forename: V P
authors.initials: VP
authors.lastname: Misra
authors.forename: S
authors.initials: S
authors.lastname: Catania
authors.forename: A J
authors.initials: AJ
authors.lastname: Lees
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001480:Basal Ganglia Diseases / Q000150:complications; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D020918:Complex Regional Pain Syndromes / Q000150:complications; D020821:Dystonic Disorders / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006225:Hand; D006801:Humans; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000187:drug effects*; D009410:Nerve Degeneration / Q000150:complications; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010300:Parkinson Disease / Q000150:complications; D016896:Treatment Outcome; D014743:Videotape Recording
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A