Case ReportThe Effect of Computed Tomography–Guided Botulinum Toxin Injection on Cervical Dystonia, Confirmed by a 9-Month Follow-Up Using Positron Emission Tomography/Computed TomographyLee, Seung Ah MD, PhD; Choi, Ja-Young MD, PhD; Oh, Byung-Mo MD, PhDAuthor Information From the Department of Physical Medicine & Rehabilitation, Kyung Hee University College of Medicine, Seoul, Republic of Korea (SAL); Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea (J-YC); and Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea (B-MO). All correspondence should be addressed to: Byung-Mo Oh, MD, PhD, Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea. Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.ajpmr.com). Online date: February 8, 2019 American Journal of Physical Medicine & Rehabilitation: January 2020 - Volume 99 - Issue 1 - p e7–e10 doi: 10.1097/PHM.0000000000001156 Buy SDC Metrics Abstract Although accurate targeting of the causative muscles is of paramount importance in the treatment of focal dystonia, this is often challenging because of distortion of the affected anatomical structures and difficulty in proper positioning of injections. We report a case of idiopathic cervical dystonia that was treated by computed tomography–guided injection of botulinum toxin into multiple deep muscles. Based on clinical presentation of combined torticollis and retrocollis, and needle electromyography results, botulinum toxin was injected under electromyography guidance. This treatment resulted in no improvement. Subsequently, target muscles were identified using 18F-fludeoxyglucose fusion positron emission tomography/computed tomography. botulinum toxin was injected into the hypermetabolic muscles guided by computed tomography. This injection successfully relieved the symptoms, and nine months of follow-up using positron emission tomography/computed tomography confirmed that hypermetabolic muscles had been normalized. This case indicated that computed tomography guidance may facilitate accurate targeting of botulinum toxin injection. To the authors' knowledge, this is the first case reporting a positive effect of botulinum toxin on cervical dystonia symptoms that lasted 9 mos, confirmed by follow-up positron emission tomography/computed tomography. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.