Background
•Belly Dancer’s Dyskinesia (BDD) is a rare movement disorder marked by involuntary, rhythmic contractions of the abdominal wall
•Etiologies include central or peripheral neurologic lesions, phrenic nerve irritation, medication effects, and prior abdominal trauma
•Symptoms can be distressing and functionally limiting and may affect breathing or digestion
•Pharmacologic therapy is often ineffective; botulinum toxin A (BoNT-A) has shown promise in isolated reports but lacks standardized dosing or injection protocols
Methods
•Written informed consent obtained for publication and academic use
•Clinical evaluation: MRI brain/spine, EMG, and neurologic assessment
Results
•Substantial symptomatic improvement in abdominal spasms
•Improved respiratory function and reduced pulmonary complications post-treatment
•No adverse reactions to BoNT-A
Case Report
•72-year-old woman with:
•Interstitial lung disease (ILD)
•History of abdominal shingles
•GERD s/p Nissen fundoplication
•Presented with visible abdominal wall spasms, consistent with BDD, causing dyspnea and oxygen desaturation during episodes
•EMG findings: 5–6 Hz rhythmic tremor in rectus abdominis and external oblique muscles
•Partial relief with clonazepam, but persistent spasms and recurrent aspiration pneumonia/pneumonitis caused by these spasms
•Intervention:
•BoNT-A injected into 20 sites total (10 per side of anterior abdominal wall)
•Total dose: 100 units via 30-gauge needle, distributed evenly along muscle bellies
•Follow-up (3 months):
•~50% reduction in spasm frequency and severity
•No adverse effects reported
•Pulmonary improvement: Recent pneumonia did not require hospitalization; pulmonologist attributed benefit to improved breathing mechanics and cough strength
Discussion
•BoNT-A may provide dual benefit in BDD with comorbid pulmonary disease:
•Reduces motor hyperactivity of abdominal wall
•Enhances diaphragmatic movement and cough mechanics
•This case study supports emerging evidence for safe, effective use of BoNT-A in abdominal wall movement disorders
•This case also highlights the need for protocol standardization and further study into BDD pathophysiology and optimal injection mapping
1. Alshubaili A, Abou-Al-Shaar H, Santhamoorthy P, Attia H, Bohlega S. Ultrasound-guided botulinum toxin A injection in the treatment of belly dancer's dyskinesia. BMC Neurol. 2016 Nov 17;16(1):226
2. Rathmann K, Hambach J, Meleshchenko N, Rohkamm R, Kermer P. Belly Dancer's Dyskinesia: 3 Cases of a Rare Entity. Case Rep Neurol. 2022 Feb 15;14(1):51-57
3. Rissardo JP, Vora NM, Tariq I, Batra V, Caprara ALF. Unraveling belly dancer's dyskinesia and other puzzling diagnostic contortions: A narrative literature review. Brain Circ. 2024 Jun 26;10(2):106-118
4. Tamburin S, Idone D, Zanette G. Belly dancer's myoclonus and chronic abdominal pain: pain-related dysinhibition of a spinal cord central pattern generator? Parkinsonism Relat Disord. 2007 Jul;13(5):317-20
