Botulinum toxin for painful torticollis in leptomeningeal disease: case reports

Torticollis is a rare but challenging complication of cancer with leptomeningeal spread (LMD) or intracranial disease. While this has been described in the pediatric literature (1,2,3) with brainstem gliomas and spinal cord tumors, it has not been reported to our knowledge in the adult literature. Cervical dystonia/torticollis in the general population has a myriad number of causes and approaches to treatment but one accepted form of treatment is injection of botulinum toxin (4,5). We had noted a number of patients in our Palliative Care Unit (PCU) who had developed torticollis seemingly related to LMD but who had failed to improve with standard therapies, and who continued to have sustained torticollis through to death.

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