摘要Background: Spasnodic torticollis (ST) is generally regarded as a disease affccting extrapyramidal system, but the real cause is still unknown. In addition to ordinary medical and surgical therapy, intramuscular botulinum toxin injection (IBTI) into appropriate neck muscles was considered as the first choice. However, the therapeutic efficacy is maintained limitedly and the advcrse reactions can not be well tolerated by all patients. From Au8 1992 to Aug 1999, we attemped d to treat 12 cases of ST with the therapy by injection of 50% alcohol into affected neck muscles combined with oral administration with composit dopar continually for about 4 months. All the patients had failed to respond to treatment by both westem and Chinese traditional medicine, includir g accupucture or IBTI before the trial. Methods: All twelve patinets (8 men and 4 women age range, 17 to 45 gers mean age,28.5-9.8) had suffered from the disease over 1 montth (course range, 1.2 to 1l;mean SD,4.27±3.46)before the therapy. In each case ,thee invclved neck-musles that were chosen for being injected into their moter points with 50% alcohol 2ml were among the splenius capitis trapezins and stemocleidomastoid museds on both sides The injections were performed twice a week in the first two weeks, then once to end. generally, the whole course stretching from 5 to 12 weeks(mean±11.67±2.10). At the beginning of the injections, the composit dopars were also started with low dosage, then gradually increasing till the stage in which the head jecks or tremor attenuated; or up to the highest dosage in which MModopar reached of 250, three times dayty or Sinemet CR 250, twice dayly. The duration of the medieation exterted form-12 weeks to 21 weeks(mean±s, 15.58±3.48). Resents: All thc patients experienced a temporary pain in the injecled muscles(100%,12/12) during and after shooting,but could tolerate. Drukenness lasting abont 20 munites appeared in 4 cases (33.23%,1/12)and a numbmess occurred-at a small injected area behind right ear in l,not disappearing completely till two months late. The neck moved with slight stiffness and the involuntary movement sibsided from 1 to 5 days after an injection. A few patients felt tired at the initial composit dopar therapy, which usually persisted throughout two weeks. If the oral therapy tumed ineffective. we stopped it for a week and then resumed effect would show again. These patients had been followed up for one to six years (mean±s,2.58± 1.35)since the end of their coures.The data showed what the curative rate touched 66.7% (8/12),relieved 8.3%(l/12),ineffective 33.3%(4/12) and the overall effective 75%. Discussion: 50% alcohol injection into monar point in a muscle was induced by Okubo and Yanagisawa, which was used to relieve the low limb extensor spasn. It was assumed that the injection might influence the Ia afferent impulses among a motor neuron, Rensaw's cell,agonist and atagonist, which can inhibit muscular spasm without myasthenia. We tried to use this mechanism for improving the neck myospasm though the later may be different from the former. Furthermore we attempted to increase the level of dopamin in the brain to make balance of netturotransitter in certain area of central nervous system,especially in the extrapyramidal one. Although the therapy with BT is decleared effective,the curative durafion can generally maintain from one to tree monthas. Moreover there may be some serious side effects:fatigoe-local pain, dysphagia,neck weakness, upper cstremity weakness or numbness and hoarseness. Condusion: The preliminary outcome demonstrates that injection with 50% alcohol combined with oral medication with composit dopar ia a effective therapy for ST without serious side effect. When the effectiveness attenuated in the oral course,never abandon it, stop for a week, then resume and there may be a dramatic improvement except the course that has been over six months.