Objective: We report three cases of focal movement disorder following trauma or surgery. Oral therapies were ineffective in both patients and symptoms dramatically improved after BoNT A injections.

Background: Injuries or surgical procedures may be a trigger for movements and muscular spasms which pathophysiology remain controversial. A central and/or peripheral nervous system dysfunction may produce abnormal discharges along the motor pathways. Oral therapy is usually ineffective and associated to significant adverse event.

Methods: Patient 1- a 49 years old man suffered from paraplegia since 12 years caused by complete spinal cord traumatic section at thoracic level. After a proximal left femur fracture following to a fall from his wheelchair he developed a sub continuous flexion spasm at the left hip affecting his daily activities, especially driving an adapted car, and quality of life. The symptoms disappeared after two subsequent treatment sessions with time interval of two months of emg-guided 1000 abobotulinum toxin units injections in iliopsoas, pectineus, sartorius, adductor longus and magnus muscles. Patient 2- a 64 years old man suffered from multiple thoracic vertebral bones fractures and subsequent arthrodesis two years before the appearance of continuous dorsal rhythmic spasm seriously affecting his quality of life, in particular lying on the bed and during sleep. The treatment consisted of 1000 abobotulinum toxin A units emg-guided injections in ten dorsal muscles points, the symptoms disappeared after 15 days and up to now we repeated the injections 4 times with a 6 months interval. Patient 3 – a 66 years old woman underwent left mastectomy and implantation of breast prosthesis; 6 months later she started with pain and movement disorder in the pectoralis region on the left and she had to remove the prosthesis. She complained of very high distress described as jumping breast not responding to oral drugs. She was injected with US-EMG all guide with 350 U of abobotulinumtoxin A in 6 sites in the pectoralis muscles. After 4 weeks there was no symptoms and no recorded pathological activity at EMG; this treatment was successfully repeated every 5 months for 2 years.

Results: In all patients BoNT A injections treatment achieved a maintained relief without adverse effects while oral therapies (AED, myorelaxants) were ineffective with significant side effects.

Conclusions: These case reports of post-traumatic or postsurgical focal spasms/movements dramatically improved after BoNT A injections suggest that this treatment could be first choice therapy also in off-label uses.

References: Dressler D. Handb Clin Neurol. 2011;100:513-38. Jankovic J. Mov Disord. 2015 Sep 15;30(11):1566-73.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/botulinum-toxin-a-bont-a-treatment-of-postsurgical-posttraumatic-focal-movements-not-responding-to-oral-therapy/