What if botox stops working for dystonia?

Hi doctor,

My daughter, who is 28 years old, was diagnosed with cervical dystonia approximately two years ago, and her condition has recently worsened significantly. Her neck persistently twists toward the right side and slightly upward, accompanied by muscle spasms that are sufficiently painful to cause her to cry on occasion. She has undergone three rounds of botulinum toxin injections, which have provided relief for approximately two months each time; however, the dystonia returns with increased severity thereafter.

Her neurologist has prescribed Baclofen at a dosage of twenty milligrams three times daily, along with Clonazepam to be used during episodes of severe symptoms. Unfortunately, these medications cause substantial drowsiness, impairing her ability to perform her work effectively. The dystonia is negatively impacting her occupation as a teacher, as she is unable to maintain eye contact with her students and feels embarrassed about her physical appearance.

Her most recent magnetic resonance imaging (MRI) scan revealed no abnormalities, and her blood tests were within normal limits.

We have researched deep brain stimulation (DBS) as a treatment option for dystonia and would like to inquire whether this procedure could be suitable for her condition. Additionally, are newer treatments available that might provide more effective relief than Botulinum toxin injections?

It is noteworthy that her dystonia worsens with fatigue and stress. Furthermore, she has recently developed a tremor in her right hand.

Please help me.

Thanks.