Sept. 15, 2026
Mayo Clinic's subspecialized neurologists have expertise and experience with electromyography (EMG)-guided injections for the treatment of dystonia. Botulinum toxin (Botox) therapy can benefit even patients with severe dystonia due to neurodegenerative disease. But successful treatment requires precise muscle selection.
"EMG targeting can be really helpful, especially in complex situations. We can hear the rhythmic discharge of the muscle generating the tremor that the patient is experiencing. That allows us to verify that we're injecting a muscle that's clinically important for the patient's dystonic tremor," says Richard B. Dewey III, M.D., a neurologist specializing in movement disorders at Mayo Clinic in Jacksonville, Florida.
As a quaternary center, Mayo Clinic treats more than 1,700 people with dystonia every year. Neurologists specializing in movement disorders enterprise-wide take time to thoroughly examine patients and discuss how dystonia and tremor affect their daily lives.
"You can't get at the crux of how disabling dystonia is just by looking at the patients. You have to glean it from talking to them and finding out the compensations they have to make," Dr. Dewey says. "For example, some patients with cervical dystonia might just have to sit in a different chair to see a television screen. But others can't drive anymore because their necks prevent them from looking over their left sides at oncoming traffic."
Botox injections are considered first line treatment for focal dystonia. "With EMG guidance, our overall outcomes at Mayo Clinic are very good," Dr. Dewey says. "Not infrequently, we see patients who gave Botox a one-time shot and didn't have the results they wanted. But Botox tends to need a couple of rounds of adjusting the dose before you reach a threshold for successful treatment. It also matters how you're injecting it and who is doing those initial injections."
The frequency of treatment varies among patients. But injections generally need to be repeated every three months. "EMG guidance gives patients the best shot at a good duration of effect, especially for the first injection attempt," Dr. Dewey says.
Mayo Clinic's dystonia treatment team includes specialists in physical medicine and rehabilitation. "We are very well versed not only in medication therapy but in physical and occupational therapy to help patients address issues of day-to-day activities," Dr. Dewey says.
That team approach, coupled with state-of-the-art technology, allows for personalized care. "Movement disorders aren't one-size-fits-all," Dr. Dewey says. "Our expertise lies in thoroughly assessing patients and in having the full repertoire of treatments available in a one-stop shop. The goal is to provide the most up-to-date, nuanced approaches for treating dystonia."
For more information
Refer a patient to Mayo Clinic.