Table 2 Examples of four disease courses during long-standing BoNT treatment and after DBS surgery

w, 60

Dystonic „no–no“ tremor, phasic/myocloniform dystonic activity of the left shoulder; TWSTRS 14

Initially in 5-year course good response with only mild TC; TWSTRS 9

After approx. 10 years pronounced TC as well as RC and LC; TWSTRS 18

Tremor markedly improved, only subtle TC and LC, no RC described; TWSTRS 13

m, 68

Moderately severe dystonia with predominant AC (30°) and TC (30°)

Relatively stable course, new LC (pre BoNT 60°, post BoNT 30°), TC and AC at the same level as before; TWSTRS 10

In particular, increase in LC and pronounced shoulder elevation, TWSTRS 26 points. Severe neck pain

Improvement of all individual components, TWSTRS 18 points, favorable effect on pain

m, 56

Moderate TC (30°) and light LC (15°), also moderately severe shoulder elevation, TWSTRS 16 points

Mainly stable course, TWSTRS after 7 years 16 points

Higher complexity with increase in LC to 16°–35°, newly added AC with retrocaput, TWSTRS 20 points

Improvement with now still slight TC (20°) and LC (15°), TWSTRS 16 points

w, 61

Moderate cervical dystonia with TC (20°) and LC (20), TWSTRS 11 points

Deterioration of TC to 45°–67°

Further deterioration in TC to 68°–90°, TWSTRS 23 points

Continued moderate-severe TC (45°–67°), also slight lateral shift and problems crossing the midline, TWSTRS 18 points