Emergency Botox clinic for dystonic patients, provided by Dr Marie-Helene Marion, neurologist.

Emergency Botox clinic, for dystonic patients, provided by Dr Marie-Helene Marion, neurologist.

Severe cervical dystonia (torticollis), head tremor,  blepharospasm  and jaw spasms are so incapacitating that patients  often can’t wait 3 months or even 3 weeks to be treated. Dr M-H Marion is available to see patients at short notice and to proceed the same day with Botulinum toxin injections.

Patients who have been recently diagnosed, and have severe dystonia or dystonic tremor, sometimes find it difficult to cope any longer with the spasms in their face or neck; they may have been referred to a specialist center but have to wait for a few weeks  (or longer) to be seen and injected. Patients also who are regularly treated, require sometimes to be injected outside their normal therapeutic schedule, because the benefit is wearing off earlier, than usual or because unpredictable life events disrupt their time table or because their dystonia  has recently flared up due to stress. These patients can also benefit from Botox emergency clinics.

They will be seen in the London BTX centre, at the Wilbraham Place practice, located in Sloane square (SW1), have the choice between 2 brands of Botulinum toxin type A, and will benefit from electromyographic guided injections if required.  The exact protocol of injections with dosages and sites of injections, documented by sketches of the body part injected, will be given to the patient before leaving the practice. The GP and the regular neurologist will be kept informed.

I hope that this Emergency Botox clinic will help patients with severe dystonic spasm or tremor to get through difficult times of their life and carry on.


What makes my head turn?

What makes my head turn? Find out with Dr Marion, neurologist which muscles of the neck are responsible of turning the head on one side in neck dystonia

What makes my head turn?

The neck muscles involved in the involuntary posture in cervical dystonia need to be identified for Botulinum toxin injections and physiotherapy. Here are some hints.

See the sketche below.

The head is placed on the top of the cervical spine and can pivot about 90 degrees on both sides. The pivot of the head is possible if one neck muscle is pulling forward and if another one on the other side is pulling backward.

The Sterno-Cleido-Mastoid (SCM) muscle

is the muscle pulling forward and rotating the head to the opposite side (right SCM turns the head to the left).

The Splenius Capitis

is the muscle pulling the head backward and rotating the head to the same side (left Splenius turns the head to the left).

The SCM muscle is a long superficial muscle easy to palpate on the front of the neck, and the Splenius is a deep muscle, difficult to palpate, behind the ear.

The shoulder muscles

In addition, there are 2 muscles which are both neck and shoulder muscles: the Levator scapulae and the Trapezius ; both lift up the shoulder, but the Levator scapulae is a deep muscle,   responsible for the posture “shoulder up and forward “ and works with the Splenius  in turning the head to the same side (the left Levator Scapulae will contribute with the left Splenuis to the rotation of the head to the left, )

The Trapezius is a superficial muscle and can contribute to the rotation of the head to the opposite side, working together with the SCM (the right Trapezius will contribute with the right SCM to the rotation of the head to the left).

These muscles are the most frequent targets for Botulinum toxin injections to control the dystonic rotation of the head. The palpation of these muscles is important, as dystonic muscles feel more bulky under the fingers.

It may sound complex but looking at the drawing should make it simpler to grasp…

Marie-Helene Marion

London BTX centre


There is more than one Botulinum toxin!

There are 4 different botulinum toxin brands available in UK; let’s Dr Marion guide you through the pharmaceutical maze of the botulinum toxin.

Various names and abbreviations are attached to Botulinum toxin.    I hope these explanations will make reading and listening about the topic less confusing….

– Botulinum toxin is called a Neurotoxin as it’s a toxin, which is active on the nerve, controlling the action of the muscles or the secretion of the glands.

-Botox is often used in newspaper, magazine and on Internet as a generic name instead of Botulinum toxin. BOTOX is one of the brand names, registered as a trademark, and it uses inappropriately like Kleenex for facial tissue paper.

-There are 3 Botulinum toxins type A (BOTOX, DYSPORT, and XEOMIN) and 1 type B (NEUROBLOC), available in UK for therapeutic uses. The FDA (Food and Drug administration which is a regulatory body for drugs in USA) has decided to give 4 different chemical names to each of these brands, as there is no standard equivalence between the numbers of units of these brands. Ona-botulinumtoxinA for BOTOX, Abo-botulinumtoxinA  for Dysport, Inco-botulinumtoxinA for Xeomin, Rima-botulinumtoxinB for Neurobloc.

-To add to the complexity of the story, the abbreviations are also changing. We used commonly Botox, BTX, and recently we have been asked to use BoNT-A (pronounce Bonte) and BoNT-B by the scientific community!

But don’t worry too much! Despite or because of all these various labels, neurologists communicate well between each other about the treatment of their patients.