The Gap in toxin service delivery is (hopefully) a unique natural experiment that this project hopes to use to ask 

a) does botulinum toxin influence disease progression, 

b) do patients retain the same response to toxin, 

c) how badly are they affected by the Gap, 

d) how well did our various strategies deal with the Gap: 

e) how should we approach any 2nd wave lockdown? 

Through the collection of routine data, such as the LIVECHART, we may be able to understand and answer these important questions. 

The LIVECHART has been routinely used at the Walton Centre for over 30 years in the botulinum toxin clinics to help optimise treatment cycles. 

By analysing these charts alongside other potential outcome measures we hope to gather new insights into how botulinum toxin works in conditions such as dystonia, spasticity, hemifacial spasm, blepharospasm and migraine.

We are interested in hearing from other units who would be interested in using the same measurement tools with their patients to build a large cohort of patients for this study.