EFFECTIVENESS OF BOTULINUM TOXIN TYPE-A AGAINST PAINFUL LIMB MYOCLONUS OF SPINAL-CORD ORIGIN

Botulinum toxin is now an established treatment for blepharospasm, hem ifacial spasm, spasmodic torticollis, and spastic dysphonia. We report the effectiveness of botulinum toxin against painful limb myoclonus o f spinal cord origin. The patient, a 16-year-old girl with a pulmonary vascular anomaly, Scimitar syndrome, suffered from an acute spinal co rd infarct at age 11. She was left with paralysis of the right leg and bladder dysfunction. Four years after the original insult, she develo ped ''painful cramping'' and involuntary movements of the left thigh, which were unresponsive to a wide range of therapeutic trials. The mov ements were continuous, rhythmic, and confined to the left quadriceps muscles. Electromyographic examination revealed continuous myoclonic d ischarges. Treatment with botulinum toxin in the left quadriceps muscl es resulted in complete cessation of pain and marked reduction in ampl itude of the movements, both clinically and electromyographically. Thi s observation indicates the efficacy of botulinum toxin in the treatme nt of painful spinal myoclonus.