Botulinum Toxin for the Treatment of Cervical Dystonia

Stephen Gollomp, MD

Department of Neurology
The Lankenau Hospital
Thomas Jefferson University
Wynnewood, PA

The most common focal dystonia, cervical dystonia is characterized by involuntary contractions in agonist and antagonist muscles of the neck. The resulting tilting and turning decreases range of motion in the neck, is usually painful, and can place a significant psychosocial burden on the patient. The precise etiology of cervical dystonia is often not known. Genetic factors likely play a role in many patients and some research suggests that trauma may contribute to triggering dystonia in susceptible individuals. Historically, treatment for cervical dystonia was limited to surgery and/or systemic medications, including anticholinergics, benzodiazepines, and antispasticity agents. First-line therapy now usually involves injections of botulinum toxin, a paralyzing agent that can be injected directly into overactive neck muscles.Botulinum toxin therapy has been recommended by the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology as safe and effective for the treatment of cervical dystonia based on numerous randomized controlled trials.

References

Albanese A, Asmus F, Bhatia KP, et al. EFNS guidelines on diagnosis and treatment of primary dystonias. Eur J Neurol. 2010 May 5. [Epub ahead of print]
Simpson DM, Blitzer A, Brashear A, et al. Assessment: Botulinum neurotoxin for the treatment of movement disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2008;70(19):1699-1706.
Ondo WG, Gollomp S, Galvez-Jimenez N. A pilot study of botulinum toxin A for headache in cervical dystonia. Headache. 2005;45(8):1073-1077.
Costa J, Espírito-Santo C, Borges A, et al. Botulinum toxin type A therapy for cervical dystonia. Cochrane Database Syst Rev. 2005;(1):CD003633.

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