Journal Article

DZNE-2026-00996

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Dystonia 3×3: A Training Guideline for Beginners in Botulinum Neurotoxin Treatment of Cervical Dystonia.

Paus, S. ; Funke, A. ; Hamacher, J. ; Haslinger, B. ; Heckelmann, J. ; Ip, C. W. ; Jost, W. H. ; Kivi, A. ; Klebe, S. ; Lee, J.-I. ; Lohmann, E.DZNE* ; Mack, F. ; Schramm, A. ; Stenner, A. ; Tacik, P.Extern* ; Walter, U.DZNE* ; Weise, D. T.

2026
MDPI Basel

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Please use a persistent id in citations: doi:10.3390/toxins18090378

Abstract: Cervical dystonia (CD) is a hyperkinetic movement disorder characterized by involuntary muscle contractions leading to abnormal postures of the head and neck. The injection of botulinum neurotoxin type A (BoNT-A) into the muscles involved is the treatment of choice for CD. BoNT-A therapy of CD requires appropriate training, which has not been standardized in Germany. To address the key challenges in BoNT-A education, an expert panel developed a simplified step-by-step treatment guideline for beginners, adapted from the established Col-Cap-Concept ('Dystonia 3×3'). Based on expert consensus, recommendations were developed for the core clinical elements of BoNT-A treatment in CD-recognition of the movement pattern, identification of target muscles, development of an injection plan, ultrasound-guided injection, and dosing, taking into account the target audience of the guideline. As such, Dystonia 3×3 provides a user-friendly beginner's guidebook, enhancing accessibility and standardization of CD treatment training. Further research is required to evaluate its clinical efficacy and suitability for training.

Keyword(s): Humans (MeSH) ; Botulinum Toxins, Type A: therapeutic use (MeSH) ; Botulinum Toxins, Type A: administration & dosage (MeSH) ; Neuromuscular Agents: therapeutic use (MeSH) ; Neuromuscular Agents: administration & dosage (MeSH) ; Torticollis: drug therapy (MeSH) ; Col-Cap-Concept ; botulinum neurotoxin type A ; cervical dystonia ; expert consensus ; training concept ; ultrasound ; Botulinum Toxins, Type A ; Neuromuscular Agents

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Contributing Institute(s):

1. Parkinson Genetics (AG Gasser)
2. Non-Motor Symptoms in Parkinson's disease (AG Storch)

Research Program(s):

1. 353 - Clinical and Health Care Research (POF4-353) (POF4-353)

Appears in the scientific report 2026

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