Abstract
Cervical dystonia (CD) is the most frequent form of focal dystonia. Symptoms often result in pain and functional disability. Local injections of botulinum neurotoxin are currently the treatment of choice for CD. Although this treatment has proven effective and is widely applied worldwide, many issues still remain open in the clinical practice. We performed a systematic review of the literature on botulinum toxin treatment for CD based on a question-oriented approach, with the aim to provide practical recommendations for the treating clinicians. Key questions from the clinical practice were explored. Results suggest that while the beneficial effect of botulinum toxin treatment on different aspects of CD is well established, robust evidence is still missing concerning some practical aspects, such as dose equivalence between different formulations, optimal treatment intervals, treatment approaches, and the use of supportive techniques including electromyography or ultrasounds. Established strategies to prevent or manage common side effects (including excessive muscle weakness, pain at injection site, dysphagia) and potential contraindications to this treatment (pregnancy and lactation, use of anticoagulants, neurological comorbidities) should also be further explored.
Highlights
Cervical dystonia (CD) is the most frequent form of focal dystonia, with an overall prevalence of 4.98/100,000 in Europe [1]
Are the Different Formulations of botulinum neurotoxin (BoNT)-A and BoNT-B Effective in Improving CD? Several randomized controlled trials (RCTs) showed that onabotulinumtoxinA, abobotulinumtoxinA, and rimabotulinumtoxinB are effective in reducing dystonia when compared to placebo [15,16,17,18,19,20,21,22,23,24,25]
One RCT showed that incobotulinumtoxinA significantly improved Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS)-total scores compared to placebo in 233 CD patients [26] and that improvement of mean TWSTRS-total (p < 0.001) and severity score (p < 0.016) persisted after repeated injection [27]
Summary
Cervical dystonia (CD) is the most frequent form of focal dystonia, with an overall prevalence of 4.98/100,000 in Europe [1]. Mood disorders, including anxiety and depression, are frequently present [3, 4]. Tetrabenazine, possibly effective [7], is limited by the frequent side effect of depression and parkinsonism. Evidence on the effectiveness of allied care treatments, including physiotherapy and cognitive behavioral therapy, is scanty [8]. In those with unsatisfactory botulinum neurotoxin (BoNT) effect, surgery may be considered. Peripheral surgery, such as selective peripheral denervation, can provide improvement in about two-thirds of cases, with frequent relapses and is rarely performed [9, 10]. Alternative DBS targets, such as the subthalamic nucleus, need further investigation [12]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
