Background: Adult focal dystonias are common movement disorders characterized by sustained or intermittent involuntary muscle contractions leading to abnormal movements and postures. Although oral medications remain widely used, Onabotulinum toxin has emerged as an effective treatment modality for focal dystonias. This study was undertaken to compare the efficacy and safety of Onabotulinum toxin injections with standard oral medications in adult focal dystonias. Objectives: To compare the efficacy of Onabotulinum toxin injections and oral medications in adult focal dystonias, assess the clinical spectrum of focal dystonias, evaluate treatment response following Onabotulinum toxin therapy, and compare adverse effects between treatment modalities. Materials and Methods: A prospective comparative observational study was conducted in the Department of Neurology of a tertiary care teaching hospital. Eighteen patients with adult focal dystonias were enrolled and followed for six months. Patients received either standard oral medications alone or Onabotulinum toxin injections in addition to oral therapy. Baseline demographic and clinical data were recorded. Disease severity was assessed using the Visual Analog Scale (VAS), functional disability scores, and frequency of spasms. Treatment response and adverse effects were evaluated during follow-up. Statistical analysis was performed using Student’s t-test, Chi-square test, Fisher’s exact test, and paired t-test, with p<0.05 considered significant. Results: The mean age of the study population was 46.1 ± 15.4 years, with equal male and female representation. Hemifacial spasm was the most common focal dystonia (38.9%), followed by cervical dystonia (22.2%) and blepharospasm (16.7%). Onabotulinum toxin therapy significantly reduced VAS severity scores from 7.4 ± 1.1 to 2.3 ± 1.0 (p<0.001), functional disability scores from 6.8 ± 1.4 to 2.4 ± 1.2 (p<0.001), and spasm frequency from 18.5 ± 6.4 to 5.1 ± 2.7 episodes/day (p<0.001). Improvement greater than 50% was observed in 90.0% of toxin-treated patients compared with 37.5% receiving oral medications (p=0.024). Treatment satisfaction was significantly higher in the toxin group (8.6 ± 1.0 vs. 5.8 ± 1.4; p<0.001). Sedation and dry mouth were more common in patients receiving oral medications, while dysphagia was infrequently observed following toxin injections. Conclusion: Onabotulinum toxin injections provide significantly greater clinical improvement, reduced symptom severity, enhanced functional outcomes, and higher patient satisfaction compared with oral medications in adult focal dystonias. The treatment is safe, effective, and should be considered a preferred therapeutic option for appropriately selected patients with focal dystonias.

Adult Focal Dystonia. Onabotulinum Toxin. Movement Disorders.