From the Guidelines
Cervical dystonia is a neurological movement disorder characterized by involuntary muscle contractions in the neck that cause abnormal head postures or movements, and its treatment primarily involves botulinum toxin injections to weaken the affected muscles and reduce contractions, as recommended by the most recent guidelines 1.
Definition and Characteristics
Cervical dystonia causes involuntary contractions of the neck and upper shoulder muscles, resulting in abnormal postures or movements of the neck, shoulders, and head, as described in the guidelines 1. These contractions can be painful and may result in the head twisting to one side (torticollis), tilting forward (anterocollis), backward (retrocollis), or to the shoulder (laterocollis).
Treatment Options
The treatment of cervical dystonia typically involves botulinum toxin injections, such as Botox, Dysport, or Xeomin, administered every 3-4 months directly into the affected muscles to weaken them and reduce contractions, with dosing varying by product and individual needs 1. Oral medications like baclofen, trihexyphenidyl, or clonazepam may provide additional relief, and physical therapy focusing on stretching and posture can complement medical treatment.
Referral and Management
According to the guidelines, primary care physicians should refer survivors with cervical dystonia to a rehabilitation specialist for comprehensive neuromusculoskeletal management, as recommended in the most recent systematic review 1. Referral to a speech-language pathologist or other specialists may also be necessary for individuals with related conditions, such as dysphagia or communication disorders.
Quality of Life and Outcomes
While cervical dystonia is typically a chronic condition, proper treatment can significantly improve symptoms and quality of life, as noted in the guidelines 1. The goal of treatment is to reduce the frequency and severity of dystonic episodes, improve range of motion, and enhance overall functional ability. By prioritizing the most recent and highest-quality evidence, healthcare providers can provide optimal care and management for individuals with cervical dystonia.
From the Research
Definition and Characteristics of Cervical Dystonia
- Cervical dystonia (CD) is a form of dystonia that involves neck muscles, characterized by sustained involuntary muscle contractions, frequently causing twisting and repetitive movements or abnormal posturing 2.
- It is estimated that there are between 60,000 and 90,000 patients with CD in the US, with the majority presenting with a combination of neck rotation, flexion, extension, head tilt, or a lateral or sagittal shift 2.
- CD can be classified into two groups: primary CD (idiopathic) or secondary CD (symptomatic), with primary CD having no evidence of any secondary cause for the dystonic symptoms 2.
Symptoms and Diagnosis
- Symptoms of CD may include neck posturing, pain, local muscle hypertrophy, and/or abnormally increased EMG activity, with abnormal movements being the defining feature 2, 3.
- However, some cases may occur without abnormal movements of the head or neck, presenting with pain, local muscle hypertrophy, or abnormal EMG activity 3.
- Sensory tricks, such as touching the chin, back of the head, or top of the head, can temporarily ameliorate dystonic movements and postures 2.
Treatment Options
- The most widely used and accepted therapy for CD is local intramuscular injections of botulinum toxin (BTX) type A, which can lead to an improvement in pain and dystonic symptoms in up to 90% of patients 2, 4, 5.
- Physiotherapy is a potentially useful adjuvant treatment, with reported improvements in head position, pain, cervical range of motion, quality of life, and activities of daily living 6.
- Other treatment options include supportive therapy, counseling, pharmacotherapy, and central and peripheral surgical therapy, with surgery usually reserved for patients with CD in whom other forms of treatment have failed 2.