Service features: The Department of Neurology of the Ninth People’s Hospital of Shanghai Jiao Tong University School of Medicine enjoys a high reputation in the field of neurology nationwide and has extensive experience in the diagnosis and treatment of dystonia, and features local injection of botulinum toxin type A (BTX-A) treatment. This technique has relatively fewer toxic side effects than traditional treatments, is relatively less expensive, and most patients can achieve improvements lasting more than 3 months, with efficacy lasting anywhere from 12 to 56 weeks, with repeat injections required for relapsing patients. Since 2013, the neurology department of our hospital has applied botulinum toxin type A to treat 62 patients with deviated facial muscles, blepharospasm Meige syndrome and spastic slant neck, with a total effective rate of 75.6%, which is consistent with many research reports. In addition, the Department of Neurology has vigorously carried out clinical observation and basic research work on dystonia. In order to promote standardized diagnosis and treatment, and to better provide quality services for the majority of patients, we have a special outpatient clinic for dystonia. The scope of diagnosis and treatment includes: blepharospasm, deviated lateral muscle spasm, Meige syndrome, spastic slant neck, and torsion spasm. Dystonia is a word that may be new to you. However, it is not uncommon to see people on the street who walk with a crooked neck, or twist their whole body, or blink their eyes repeatedly, or pucker their mouths. In fact, some of those people may be dystonia. To put it bluntly, dystonia is a condition where the whole or a part of the body is repeatedly twisted and appears in an abnormal position. Common manifestations include repeated and continuous blinking of the eyes and inability to open them after closing (we call it eyelid spasm); repeated involuntary twisting of the neck resulting in a crooked neck (spastic squint); involuntary twisting of the limbs or body (twisting spasm), etc. Some patients may also have speech difficulties, slurred words, limb tremors and other manifestations. In fact, abnormal limb twisting and posture can cause great psychological and physical pain to patients, and some patients may gradually lose their daily motor ability and functional blindness as the disease progresses. Therefore, it is important to seek medical attention in a timely manner when encountering these conditions. In order to relieve the discomfort of having her head on the left side and the embarrassment of communicating with others, Ms. Wang had to use the strength of her left hand to make her head on the left side turn to the front. Her husband took the beauty-loving Ms. Wang to seek medical treatment, acupuncture, massage, medicine, and examination, and spent a lot of money, but she still did not get better. The pain and suffering made Ms. Wang’s temper bad, and she was reluctant to communicate with relatives and friends under the influence of low self-esteem, and spent all day at home with her husband. Ms. Wang originally had a beautiful family, and the couple was very loving, their baby is less than one year old, but since Ms. Wang’s illness in the past three months, Ms. Wang’s husband can understand his wife’s pain, but sometimes also because of his wife’s “strange disease” and feel unbearable, the relationship between the young couple has deteriorated sharply. The husband gradually lost confidence in her and could not bear her torture. In January of this year, her husband brought her to the Department of Neurology of Shanghai Ninth People’s Hospital with a last ray of hope, and was examined by Director Liu Jianren, who confirmed that the patient was suffering from spastic squinting neck, a form of dystonia. After ruling out organic and psychiatric diseases, Director Liu decided to treat her dystonia with botulinum toxin after careful consideration, and after one injection treatment, Ms. Wang’s crooked neck is now corrected and her quality of life has been greatly improved. Dystonia and Parkinson’s disease belong to the same category of movement disorders and are common diseases in neurology. Dystonia is an extrapyramidal disorder characterized by involuntary limb movements and postural abnormalities caused by intermittent uncoordinated contractions or excessive sustained contractions of the active and antagonistic muscles. Symptoms are pronounced during exercise and emotional excitement, diminish at rest or in silence, and disappear during sleep. Patients are prone to low self-esteem and even depression due to prolonged strange expressions or postures and reduced quality of life. Dystonia is a treatable disease. The progression of symptoms can be controlled by internal medication, local injections of botulinum toxin type A or surgery to restore the ability to perform daily movements. Local injections of botulinum toxin type A are preferred for limited or segmental dystonia, while oral medications plus selective local injections of botulinum toxin type A are recommended for generalized dystonia. Surgical treatment may be considered in severe cases where drugs or botulinum toxin type A are ineffective. However, the effect of oral medication is mild and transient, and increasing the dose can produce intolerable systemic toxic effects, although local symptoms are improved. Although the corresponding surgical treatment is effective, it is often accompanied by irreversible nerve damage and a significant number of cases of recurrence, while acupuncture does not have definite efficacy. At present, local injection of botulinum toxin type A is a simple, easy, safe and effective treatment for most patients with dystonia, with an effective rate of 70% to 100%, especially for patients with facet spasm, blepharospasm, oromandibular dystonia, laryngeal dystonia and spastic squint, botulinum toxin can be the drug of choice, avoiding the inefficiency and toxic side effects of oral drugs and the risks of surgical treatment Botulinum toxin type A blocks (inhibits) the release of acetylcholine from the neuromuscular junction through cleavage of acetylcholine synaptic vesicle membrane proteins, thus causing muscle relaxation paralysis and relieving muscle spasm. Since the toxin generally cannot cross the blood-brain barrier and only selectively acts on peripheral cholinergic nerve endings, no serious toxic adverse reactions have been seen even after several repetitions. The effect is seen in most patients in 3-7 days and maintained for about 9-52 weeks. Some relapsed patients need to be reinjected after 3-12 months, and the efficacy may diminish after repeated injections. Adverse reactions include local pain, bruising, hematoma, and a small proportion of patients may experience side effects such as drooping eyelids and crooked corners of the mouth, and in severe cases, there may be general weakness, and these manifestations are caused by the direct action of the drug leading to muscle weakness or drug diffusion, which is difficult to avoid completely, and the duration is usually transient, and the adverse reactions can be alleviated by adjusting the dose and injection site in subsequent injections to obtain satisfactory The therapeutic effect can be reduced by adjusting the dose and injection site. In conclusion, dystonia is a complex group of clinical syndromes, and there is a lack of effective clinical means to cure it. At present, local injection of botulinum toxin type A is a simple, easy, safe and effective treatment for most patients with dystonia.