Cervical Dystonia Relieved with EMG-Guided Botulinum Toxin Therapy
PATIENT PROFILE
| Field | Detail |
| Age | 45 years |
| Gender | Female |
| Presenting Complaint | Involuntary leftward neck twisting with pain for 14 months |
| Condition | Cervical dystonia (left laterocollis with torticollis) |
| Treatment | EMG-guided botulinum toxin injection |
| Treating Neurologist | Dr. Guruprasad Hosurkar, KIMS Hospital, Mahadevapura |
Note: Patient identity is representative; clinical details reflect a typical presentation.
THE PROBLEM
A 45-year-old schoolteacher presented with a 14-month history of her head pulling involuntarily toward the left shoulder. What began as occasional neck stiffness had progressed into sustained, painful muscle pulling that worsened through the day. She described a constant ache along the left side of her neck, a fine tremor when she tried to hold her head straight, and growing difficulty driving, reading, and facing her classroom. Over-the-counter painkillers and physiotherapy gave only short-lived relief, and the visible head posture had begun affecting her confidence at work.
She had earlier been told the problem was muscular and stress-related. A friend whose father was treated for a similar movement disorder suggested she consult a leading neurologist in Bangalore who specialises in conditions of this kind.
CONSULTATION AND CLINICAL ASSESMENT
At the first consultation, Dr. Guruprasad Hosurkar took a detailed history and performed a focused neurological examination. The pattern of involuntary posturing, the presence of a partial sensory trick that briefly eased the pull when she touched her chin, and the absence of weakness or sensory loss pointed clearly toward a focal movement disorder rather than a structural or purely muscular cause.
Key examination findings:
- Posture: Sustained leftward head tilt with rotation, partially correctable with a sensory trick.
- Muscle involvement: Overactivity localised to the left sternocleidomastoid, splenius capitis, and trapezius.
- Tremor: Fine dystonic head tremor on attempted midline holding.
- Imaging: MRI brain reported normal, ruling out a secondary structural cause.
The diagnosis was idiopathic cervical dystonia. As an experienced movement disorders specialist, Dr. Hosurkar explained that botulinum toxin injection is the recognised first-line treatment for this condition.
Treatment Plan and Procedure
Dr. Hosurkar mapped the specific overactive muscles driving the abnormal posture and planned EMG-guided botulinum toxin injections to relax them selectively while preserving normal neck function. EMG guidance was used to confirm needle placement within the precise target muscles, improving accuracy and reducing the risk of spreading the effect to unintended areas.
The treatment protocol:
- Muscle mapping: Clinical and EMG identification of the left sternocleidomastoid, splenius capitis, and trapezius as primary targets.
- Dosing: Individualised botulinum toxin units divided across the mapped muscles based on severity and bulk.
- Technique: EMG-guided injections delivered in a single outpatient sitting, no anaesthesia required.
Aftercare: Gentle neck mobility advice, posture guidance, and a scheduled review at 4 weeks.
Treatment Journey at a Glance
| Stage | Timeline | Action | Status |
| Consultation | Day 1 | History, exam, MRI review | Diagnosis confirmed |
| Injection | Day 1 | EMG-guided botulinum toxin | Completed |
| Early effect | Days 5 to 10 | Muscle pull begins easing | Improving |
| Review | Week 4 | Response and dose check | Marked relief |
| Maintenance | Every 12 to 16 weeks | Repeat injection cycle | Ongoing |
Outcome and Post-Treatment Results
The patient noticed the involuntary pull starting to soften within the first week. By the four-week review, the leftward head posture had substantially reduced, the neck pain had settled, and the dystonic tremor was far less noticeable. She was able to hold her head in a near-neutral position, return comfortably to teaching, and resume driving without strain. Dr. Hosurkar confirmed a strong response and planned a maintenance schedule of repeat injections every 12 to 16 weeks, since botulinum toxin provides reliable but time-limited relief that is sustained through periodic re-treatment.
PATIENT FEEDBACK
Google Review ★★★★★ 5.0 — Verified Patient (Name withheld for privacy)
“For over a year I thought I would just have to live with my head pulling to one side. After the injections, I could finally hold my head straight again and the pain was gone. Going back to my classroom without feeling self-conscious meant everything to me.”
Profile: Female │ 45 years │ Banglore
Why Patients Choose Dr. Guruprasad Hosurkar
With over 22 years of experience and a dedicated focus on movement disorders, Dr. Guruprasad Hosurkar brings precise, EMG-guided expertise to the treatment of cervical dystonia and related conditions. As Director and Clinical Lead of Neurology at KIMS Hospital, Mahadevapura, he combines accurate muscle mapping with an individualised, compassionate approach, helping patients regain control, comfort, and confidence in their daily lives.
| Doctor | Dr. Guruprasad Hosurkar, Neurologist |
| Clinic | KIMS Hospital, OPD Room F-09, Mahadevapura, Bangalore 560037 |
| Phone | +91 9008933554 |
| Website | drguruprasadhneuropdspecialist.com |
Disclaimer:
This case study is for educational and informational purposes only and should not be considered medical advice. Individual results vary. Please consult a qualified neurologist for diagnosis and treatment.