Abstract
BACKGROUND: Many patients with hypermobile Ehlers-Danlos Syndrome (EDS) suffer from cervical dystonia. Intramuscular injection of botulinum toxin may exacerbate myeloradiculopathy or atlantoaxial subluxation in this patient population. CASE: Three patients with hypermobile EDS underwent low-dose OnabotulinumtoxinA injections for cervical dystonia into myofascial sites selected using Fascial Manipulation diagnostic sequencing technique. All patients improved in clinical symptoms without complications. RESULTS: Patients clinically improved on the TWSTRS by 16 points with demonstrated changes in deep fascia thickness decrease of 0.28 mm. DISCUSSION: Low-dose OnabotulinumtoxinA injections into carefully selected sites is a safe and effective treatment in hypermobile EDS patients suffering from cervical dystonia.