From the Guidelines
For a 6-year-old male with cervical dystonia, botulinum neurotoxin should be considered as a treatment option, specifically OnaBoNT-A or incoBoNT-A, due to their similar efficacy and safety profile, as established in the 2017 guidelines update 1. The workup for cervical dystonia in a child should include a thorough history and physical examination to rule out other movement disorders. Key points to focus on in the history include:
- Characteristics of the neck movements or postures
- Triggers or factors that exacerbate or relieve the symptoms
- Associated symptoms such as pain or headache
- Family history of similar conditions
- Impact on the child's functioning and quality of life A neurological examination should assess for any signs of other neurological conditions that could be contributing to or mimicking cervical dystonia. Given the effectiveness of botulinum neurotoxin in treating cervical dystonia, as noted in the guidelines update 1, this treatment should be considered if the condition causes significant distress or functional impairment. The choice between different formulations of botulinum neurotoxin, such as OnaBoNT-A and incoBoNT-A, can be based on their similar efficacy and the specific clinical context, including the child's overall health status and potential side effects. It's also important to educate the parents about the condition, its treatment options, and the potential benefits and risks of botulinum neurotoxin therapy, as well as the importance of follow-up to adjust the treatment plan as needed. The treatment plan should prioritize minimizing symptoms and improving the child's quality of life, with considerations for the potential impact of the condition and its treatment on the child's daily activities, social interactions, and psychological well-being.