Cervical dystonia (CD) is a rare movement disorder marked by involuntary neck muscle contractions. Although somatosensory dysfunction has been proposed, the underlying pathophysiology remains unclear. Temporal discrimination (TD) deficits are discussed as potential markers of a dystonic endophenotype, possibly linked to proprioceptive impairments. This study aimed to assess TD in the neck region and explore its relationship with proprioception in head movements. We evaluated somatosensory temporal discrimination threshold (STDT) and temporal discrimination movement threshold (TDMT) in 20 CD patients and 20 healthy controls (HC). Both measures were applied directly to the cervical region: STDT via skin stimuli on the lateral neck and TDMT via muscle stimuli to the splenius capitis. Proprioception was assessed through a head rotation task. Clinical severity was measured using the TWSTRS scale. STDT and TDMT thresholds were significantly elevated in CD patients compared to HCs and correlated positively with dystonia severity. However, there were no group differences in proprioceptive performance, nor was proprioception correlated with TD or TWSTRS scores. TD is clearly altered in CD and associated with symptom severity, supporting its role in dystonia pathophysiology. In contrast, no proprioceptive deficits were observed, and no link between TD and proprioception was found. This suggests TD and proprioception may represent distinct dysfunctions rather than connected elements of sensorimotor integration. Further studies are needed to refine proprioceptive testing in CD and clarify its relationship with TD.

Striatal compartment and white matter alterations in focal dystonia Subtypes: An MRI study.

Deep brain stimulation (DBS) targeted to the globus pallidus (GP) can effectively alleviate dystonia symptoms. However, identifying optimal therapeutic stimulation parameters is challenging due to the manual programming process and the paucity of acute effects of DBS on dystonia symptoms. This study aimed to investigate evoked resonant neural activity (ERNA) in the GP as a potential biomarker to guide DBS contact selection for chronic therapy in patients with dystonia. In n = 8 patients (n = 9 hemispheres) undergoing GP DBS implantation for dystonia, intraoperative local field potential (LFP) recordings were acquired at resting state (30 seconds) and during bursts of high-frequency stimulation delivered from each DBS contact. ERNA features (amplitude, frequency, and number of peaks) were measured and correlated with dystonia symptom severity, resting-state LFP spectral power, and postoperative chronic (12-month) therapeutic stimulation parameters. ERNA was consistently elicited by GP DBS but varied in amplitude, frequency, and number of peaks across individuals and stimulating contacts. Higher ERNA amplitudes were associated with stimulation at the GP internus/externus border. ERNA frequency was negatively correlated with cervical dystonia severity (P < 0.001) and resting-state alpha (8-12 Hz) power (P < 0.05). In eight of nine (88.9%) hemispheres, the DBS contact that elicited the maximum ERNA matched the contact empirically selected for chronic therapy by expert clinicians through routine clinical programming. Based on its correlation with dystonia symptom severity and therapeutic contact for chronic DBS, ERNA shows promise as an objective candidate biomarker to improve the efficiency and efficacy of DBS for dystonia. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Background/Objectives: Cervical dystonia (CD) is the most common focal dystonia, but nationwide evidence on healthcare use is limited. This study assessed trends in utilization and expenditures in Korea. Methods: Using National Health Insurance Service claims (2017–2023), we identified CD patients (ICD-10 G24.3) and analyzed annual patients, visits, and expenditures by demographics, medical system, service type, and specialty. Results: A total of 6614 patients (33,896 claims) were included. Patient numbers declined until 2021 then slightly rebounded, and total expenditures fluctuated. Women were more prevalent, but men incurred higher costs. Western Medicine (WM) expenditures tended to increase while Korean Medicine (KM) tended to decline. Core botulinum toxin costs remained broadly stable; physiotherapy and diagnostic testing increased, particularly WM outpatient testing. Outpatient injection-related and anesthesia expenditures showed decreasing tendencies, while hospitalization and radiology exhibited modest or minimal changes. Neurology managed the most patients, while neurosurgery generated the highest costs. Conclusions: CD care in Korea showed declining patient numbers alongside overall stable total expenditures, with increasing use of rehabilitation and diagnostic services and continued stable use of botulinum toxin as a core therapy.

The Col-Cap classification for cervical dystonia (CD) is proposed to optimize treatment strategy with botulinum toxin type A (BTX-A). Although this concept has been used for 15 years, the efficacy of BTX-A in various CD patterns remains unclear. The present study compared the efficacy of BTX-A aided by single-photon emission computed tomography (SPECT) and electromyography (EMG) in various CD patterns. CD patients who underwent SPECT scan to detect dystonic muscles were included. Candidate muscles were firstly selected by clinical evaluation and abnormal radioactivity on SPECT imaging. All patients were injected under the guidance of EMG and only those candidate muscles with positive EMG were injected. The efficacy of BTX-A was measured by subjective clinical improvement rate and the reduction rate of Tsui score at four weeks after injection. The study enrolled 252 patients. The subjective improvement rates were 63.5 ± 20.6% in simple types and 59.9 ± 22.2% in complex types, showing no significant difference (p = 0.247). The reduction rates of Tsui score showed no difference between the simple type (52.4 ± 24.2%) and the complex type either (49.6 ± 23.6%, p = 0.556). There were no significant differences in clinical improvement rates within each group of simple subtypes, complex subtypes, or patients with different types of tremors (p > 0.05). Different CD patterns exhibited comparable efficacy of BTX-A due to appropriate selection of dystonic muscles aided by SPECT and EMG, indicating that by employing multifaceted approaches to identify dystonic muscles, favorable outcomes can be achieved even in complex cases.

Introduction: Dystonia can be seen in 30% or more of patients suffering with Parkinson’s disease (PD) and sometimes can precede overt parkinsonism. However, prevalence and clinical features of cervical dystonia (CD) in PD patients have not been well characterized and retrocollis is even rarely seen among these PD+CD cases. Pathological basis of association between CD and PD is not well understood while interplay of subthalamic nucleus (STN) and globus pallidus interna (GPi) is playing central role in both diseases’ pathophysiology. Interestingly, DBS for PD can cause dystonia such as blepharospasm and bilateral pallidal DBS for dystonia can result in features of parkinsonism. We aim to present case series of PD with retrocollis as CD and effect of deep brain stimulation (DBS) surgery on retrocollis.Method: We performed a single-center retrospective analysis of PD patients who underwent DBS surgery at our center and had retrocollis as a dystonic feature. Study included patients aged &gt;18 years who were admitted between January 2024 and February 2025 for DBS surgery (n = 3). For each case, preoperative med-on and med-off UPRDS evaluations and postoperative patient records are evaluated.Results: Only 5 patients had minor skin problems which necessitatCase 1 was 61 years old male patient with right side onset PD, using levodopa+carbidopa (LD+CD) and clonazepam for hand tremor and cervical retrocollis. Operated for bilateral STN DBS. During programming sessions, patient had better response on lower contacts and higher frequency (180 Hz). It was possible to stop clonazepam and to reduce dosage of LD+CD after DBS. Case 2 was 55 years old female patient with right side onset PD, using LD+CD and rivotril for tremor, dyskinesia and cervicothoracal retrocollis. She had PD for 14 years. She operated for bilateral GPi DBS. During even second programming session, her dystonia cessated and it was possible to stop clonazepam and to reduce dosage of LD+CD after DBS. Case 3 was 61 years old male patient with left side onset PD. He had PD for 5 years and using levodopa+benserazid. His main complaints were tremor and cervical retrocollis which are responsive to challenge test. He had operated for bilateral STN DBS. After surgery, he especially benefited from tremors and also had a decrease in cervical retrocollis, although he still had to actively correct his posture while walking.Conclusions: CD is a frequent symptom in PD and our findings suggest that retrocollis as CD also can be seen in PD. Pathological bases of CD and PD in the GPi may explain how development and treatment of PD can ameliorate symptoms of CD. However, STN-DBS also can be useful in suppressing CD in PD patients, most probably due to interplay of STN with GPi. This has even more importance in tremor dominant PD cases. Frequency of retrocollis in PD, effect of STN-DBS on retrocollis and best programming parameters for this challenging symptomatology still needs studies with larger cohorts.

Introduction: Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is an established treatment for medically intractable dystonia. Dystonia clinical presentation is heterogenous and response to DBS is variable. DBS devices capable of recording local field potentials (LFPs) have recently become available for clinical use. Closed loop adaptive DBS (aDBS) has been used for Parkinsons’s disease by using beta peaks as a biomarker to alter stimulation in real-time to best suit the patient. Reliable biomarkers to use in aDBS algorithms for dystonia are yet to be established. We report findings from the use of a DBS system capable of recording LFPs in a single centre with the aim of identifying potential biomarkers that could be used in the optimal programming of DBS systems and potential use of aDBS in dystonia.Method: Clinical data and GPi LFPs were recorded from 3 patients with cervical dystonia implanted with Medtronic SenSight leads and Percept RC DBS systems from 10/01/24 to 26/07/24. GPi LFP data were collected using Medtronic BrainSense during the activation and programming visits. These data were exported and analysed in MATLAB to compute long term LFP timelines and power spectra, the latter with varying stimulation settings.Results: Long-term recordings of LFPs evidenced increased LFP power over time even while stimulation is turned off. Power spectra while stimulation was turned off evidenced significant oscillatory activity in the theta and alpha range but also increased activity across the beta frequency band. There was no clear correlation between the lateralisation of dystonic symptoms and theta-alpha power in the ipsilateral or contralateral hemisphere. When stimulation was turned on or increased, temporary increases in LFP power in the theta-alpha band, followed by a sustained decrease were seen in 2 patients. These increases in LFP power were also mirrored in the contralateral hemisphere. Fluctuations in beta band activity were also seen when the stimulation current was changed in 1 patient.Discussion: The effect of increased LFP power over time from the date of implantation while stimulation is turned off could be explained by the microlesion effect. Oscillatory activity in the theta-alpha band has been well documented previously and has been associated with dystonia severity. The role of pallidal beta oscillations in dystonia is contested but recent studies have suggested that there is a negative correlation between beta power in the GPi and dystonic severity and that the ratio of beta to alpha power correlates with potential benefit from DBS, and thus the presence of beta activity may present a useful biomarker for DBS and could potentially be used as a guide during implantation of DBS electrodes. The lack of correlation between interhemispheric differences in theta-alpha band power is likely a result of the small size of the sample. The effect of increased LFP power in the contralateral hemisphere to the one where stimulation was being increased provides some evidence for interhemispheric pallidal connections in dystonia which warrants further exploration.Conclusions: Our findings suggest that beta power and LFP dynamics such as bursting should also be considered as potential biomarkers to be used in future aDBS algorithms in dystonia alongside theta-alpha power.

BackgroundPatients with cervical dystonia (CD) commonly exhibit varying degrees of impaired balance, abnormal gait, and increased fear of falling. However, Botulinum toxin—the standard of care—does not substantially improve balance or gait. Baduanjin, a traditional Chinese exercise, improves balance in several neurological disorders, yet its effects in CD remain unknown. This protocol describes a randomized controlled trial evaluating the effects of Baduanjin exercise on balance impairment in patients with CD.MethodsThis prospective randomized controlled trial enrolls CD patients with impaired balance. Eligible participants are randomly allocated (1:1) to either a Baduanjin intervention group or a control group without Baduanjin. The Baduanjin group undergoes a 20-week training program. The primary outcome is balance function, evaluated through the Berg Balance Scale. Secondary outcomes include standing static balance ability assessed by the Zebris Stance Analysis FDM System, fall risk conducted using the Timed Up & Go test, gait-related data assessed by the Zebris Gait Analysis FDM System, the severity of CD assessed by the Toronto Western Spasm Rating Scale, and the anxiety status of patients assessed by the Hamilton Anxiety Rating Scale. The entirety of the data are collected at the baseline, 2, 6, 12, and 20 weeks. A two-way mixed analysis of variance (ANOVA) or generalized estimating equations are used to assess the effectiveness of Baduanjin.DiscussionThis protocol is the first randomized controlled design to evaluate Baduanjin for balance and gait in cervical dystonia, combining objective instrumented outcomes with validated clinical scales and a pragmatic supervised-to-home regimen, thereby providing decision-relevant evidence.Clinical trial registrationhttp://itmctr.ccebtcm.org.cn/zh-CN/Home/ProjectView?pid=fce76993-0978-484e-ba50-c097b35805c7, ITMCTR2024000240.

Does the ability to stop ongoing movement differentiate cervical dystonia from functional cervical dystonia?

Efficacy and safety of DaxibotulinumtoxinA for injection in adults with cervical dystonia: Pooled global analysis of ASPEN-1 and ASPEN-1-CN randomized trials.

In this era of modernization and fast life, everybody is busy and living stressful life. Neck pain is common now a days, due to fast developing technical era people can’t concentrate on their proper regimens and facing problems like Manyasthambha. Manyastambhais defined under Nanatmaja Vatavyadhi. It is a disease where, the Vikruta Vata get lodges in the Manya Pradesha causing symptoms like Stambha and Shoola. Manyastambha can be corelated with symptoms of Torticollis. Objective: This single case study the efficacy of Valuka sweda, greeva basti and Pippalyadi Avapeedana Nasya in the management of Manyastambha. Methods: A case report of female patient where, 45-year-old with a chief complaint of Manyastambha and Manya shoola and restricted movements in the cervical joints. Two outcome measures were used for the assessment: Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) severity score. Assessment was conducted on the 0th and 8th day. Results: Torticollis can be effectively managed using Valukasweda, Greevabasti and Pippalyadi Avapeedana Nasya. There was clinically significant difference in pain intensity and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores on the 0th day and 8th days. Conclusion: Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores on the 0th day and 8th days was reduced from 57 to 48. Hence, Valukasweda, Greevabasti and Pippalyadi Avapeedana Nasya in the management of Manyastambha.

IntroductionSpasmodic torticollis may require surgical intervention, such as intradural rhizotomy, when medical treatments are ineffective. It is important to recognize the nerve of McKenzie, which is a connection between the C1 ventral root and the spinal accessory nerve. It exists in some cases, and if overlooked, it can lead to persistent symptoms. The findings establish a foundation for enhancing outcomes in neurosurgical interventions for spasmodic torticollis by improving understanding of this uncommon neural entity.MethodsWe included 30 formalin-fixed adult human cadavers (15 female and 15 male) without any previous spinal surgical procedures, pathology of the spinal cord, or non-traumatic pathology. The age range of the cadavers was 60 to 95 years (mean: 77.5 years). Utilizing a posterolateral approach, the craniocervical junction was exposed. The occipital bone and posterior neural arch of the C1-C7 vertebrae were excised, and the meninges were cleaned. The spinal accessory nerve course was traced, and the McKenzie nerve and surrounding vascular relations were identified and documented.ResultsThe McKenzie nerve was observed in six out of 60 sides (10% prevalence). Prevalence was equal between sexes but more frequent on the right side (66.7%). Mean nerve length was greater on the right (5.8 ± 0.61 mm) compared to the left side (5.05 ± 0.07 mm). Bilateral occurrence was noted in two specimens. Two specimens exhibited bilateral absence of C1 dorsal roots. The presence of the McKenzie nerve was statistically significant (p=0.04).ConclusionIn our research, we observed that the McKenzie nerve tends to be longer and more frequently found on the right side. In two specimens, it was present bilaterally, highlighting the necessity for a comprehensive bilateral examination due to the possibility of it occurring on both sides. These findings highlight the necessity for meticulous attention during surgical interventions for spasmodic dystonia. Failure to identify the McKenzie nerve could result in incomplete symptom relief. These observations may contribute to improved surgical outcomes.

Heterogenous, small cohorts, and co-occurrence of pain and psychiatric burden complicate understanding of sleep in dystonia. To investigate sleep concerns in cervical dystonia (CD). Longitudinal data from CD-PROBE on subjects who were toxin-naïve, new to practice, or without injections for at least 16 weeks were analyzed. Cervical Dystonia Impact Profile captured sleep disturbances. Impact of OnabotulinumtoxinA on sleep was assessed using multilevel mixed models, controlling for demographics, dystonia severity, mood, and pain. 56% (n = 1037) reported concerns with sleep initiation, restfulness, maintenance, and total time. Initial injection led to a clear improvement in sleep. (P < 0.001) Motor severity (β: 0.20, P < 0.001), mood (β: 0.36, P < 0.001), and pain (β: 0.58, P < 0.001) predicted sleep improvement (n = 502) over three OnabotulinumtoxinA cycles. Sleep concerns are common in CD, with initial and subsequent improvement with OnabotulinumtoxinA. Impact of mood and pain on sleep highlights the importance of non-motor features.

Cervical Dystonia (CD) is now recognized to encompass a constellation of non-motor symptoms, including sensory, cognitive, and psychiatric manifestations, which significantly affect patients' quality of life. Cerebellar dysfunction may affect cognitive and affective processing in CD, mirroring cognitive and affective patterns observed in Cerebellar Cognitive and Affective Syndrome (CCAS). To investigate impairments in cerebellar-dependent cognitive and affective domains in CD patients using the Cerebellar Cognitive and Affective Syndrome scale (CCAS-S), and to analyze the potential relationship between cognitive deficits and clinical features of CD. The CCAS-S was administered to twenty CD patients and twenty controls (HC) matched for age, gender, level of education, and MMSE score. For CD patients, disease severity and disability were evaluated using the Toronto Western Spasmodic Torticollis Rating Scales (TWSTRS), while tremor was assessed through the Fahn-Tolosa-Marin Clinical Rating Scale for Tremor (FTM). CD exhibited a significantly lower total CCAS-S score, and a higher number of failed items compared to HC, with marked deficits in specific sub-items such as fluency, delayed verbal recall, similarities, and affective domain. The total number of failed tests revealed high predictive ability (AUC = 0.90), with no significant correlations between disease duration, clinical outcomes, and CCAS-S performance. The CCAS-S is a sensitive screening tool in differentiating cognitive performance in CD and HC, showing a critical cerebellar involvement in the cognitive and affective symptoms of dystonia.

Whether the traditional distinction between segmental and multifocal dystonia is clinically or scientifically useful remains unclear. To evaluate whether idiopathic isolated adult-onset segmental and multifocal dystonia can be differentiated based on clinical features other than the contiguity of affected body regions. We compared data on segmental and multifocal dystonia from two large dystonia databases established in the USA and Italy that used similar criteria for patient recruitment and assessment. Compared to segmental dystonia, multifocal dystonia was characterized by a higher proportion of men, a younger age at dystonia onset, a greater frequency of upper limb dystonia, and a lower frequency of cranial dystonia at both onset and last examination. Segmental and multifocal dystonia had a similar frequency of alleviating maneuvers, non-motor eye symptoms in blepharospasm, and neck pain and tremor in cervical dystonia. Although the initial spread pattern from focal to segmental or multifocal appeared faster in the segmental dystonia group, adjusting the analysis for the initial body site involved revealed no significant differences between the two groups. Segmental and multifocal dystonia starting in the same body site showed similar age, sex, and spread characteristics. The observed differences and similarities were consistent across both independent databases. Segmental and multifocal dystonia share differences and similarities. The observed differences may reflect a difference in the predominant site of dystonia onset. From a clinical perspective, therefore, the segmental/multifocal distinction is probably not valuable in the dystonia classification scheme, although further data may be needed from a pathophysiological perspective.

Deep brain stimulation (DBS) targeting the globus pallidus internus (GPi) or subthalamic nucleus (STN) is well established for treatment of craniocervical dystonia (CCD). This study aims to compare the long-term outcomes of GPi-DBS and STN-DBS for CCD and identify potential prognostic factors. This retrospective study analyzed 78 consecutive patients with CCD treated with bilateral DBS at a single medical center, comprising 2 nonrandomized cohorts: GPi-DBS (n = 38) and STN-DBS (n = 40). Motor and nonmotor symptoms were assessed using standardized rating scales at baseline, 6 months, and 1, 2, 3, and 4 years after surgery. Multiple linear and logistic regression analyses were performed to identify potential prognostic factors for long-term outcomes. At 6 months, the STN group showed greater improvement in motor symptoms compared with the GPi group (50.48% [95% CI, 40.12%-60.84%] vs 34.92% [95% CI, 24.84%-45.00%], P = .046), although this difference was not significant after adjusting for multiple comparisons (threshold P < .01). No significant differences in motor symptom improvement were observed between the 2 groups at later follow-up points. Among all Burke-Fahn-Marsden dystonia rating scale movement subscale scores, the STN group showed greater improvement in the eye subscore at 6 months, 2 years, 3 years, and 4 years, but these differences were also not significant after adjusting for multiple comparisons. Both groups demonstrated significant improvements in mood and quality of life at the last follow-up. Cognitive functions remained stable. Multiple regression analysis revealed a negative correlation between disease duration and motor improvement (standardized β = -.023, 95% CI, -0.044% to -0.003%, P = .028). Both GPi- and STN-DBS can effectively improve motor symptoms and quality of life of patients with CCD, with comparable long-term efficacy. Early intervention is critical, with disease duration being an important prognostic factor for long-term motor improvement.

Cervical dystonia (CD) is an urgent problem in neurology and healthcare in general. One of the CD manifestations is head tremor, which affects up to 60% of patients. Dystonic tremor is a spontaneous, oscillatory, rhythmic, and unstable patterned movement resulting from contractions of dystonic muscles, often exacerbated by an attempt to maintain the primary (normal) posture. Head tremor is a separate issue for patients diagnosed with CD. Physical difficulties and emotional experiences are different in CD patients with and without tremor. Patients with CD often face limitations in their daily lives, including difficulties with performing work duties, managing the household, and participating in social activities. It is especially true for the working-age population, since the disease often develops in people aged 30-50 years. CD, especially with dystonic tremor, is associated with severe adverse emotional experiences of patients, anxiety, and depression due to a visible ailment, resulting in self-stigmatization. Psychological difficulties and a negative perception of their appearance and condition also contribute to the social isolation of patients, which makes the disease not only physical, but also psychosocial. The quality of life reflects the significance of non-motor dystonia symptoms, including depression.

To analyze the efficacy of eperison in combination with botulinum toxin injections for the treatment of pain syndrome in patients with spastic torticollis (ST). A retrospective study was conducted to evaluate the effectiveness of eperison administration alongside botulinum therapy in 29 patients diagnosed with ST. The study employed a cross-sectional retrospective analysis of medical data. Patients receiving botulinum toxin injections at three-month intervals (a total of 6 cycles), with assessments at 2 months (4-6 cycles after each injection), were administered eperison at a dose of 150 mg/day. The efficacy of the treatments was evaluated using a validated scale: the 85-point TWSTRS (Toronto Western Spasmodic Torticollis Rating Scale), assessed three times-before each botulinum injection (on day 1), at day 14, and and at day 60 later. For cycles 1-3 (botulinum toxin, without eperisone), the average TWSTRS scale score on the on day 1 of each cycle was 40.72 - 41.66; cycles 4-6 with the addition of Eperisone - 26.6-30.4 points. When comparing the average values of the TWSTRS scale for cycles 1-3 and cycles 4-6 on the «Pain» scale, t-test value was: 15.85 (p=0.000546). The intake of the centrally acting muscle relaxant eperison resulted in a statistically significant improvement in patients with ST by the time of the next injection (paired Student's t-test 2.77-2.92, p=0.05), including improvements in the «Pain» scale, compared to botulinum therapy without eperison in the same patients.

Cervical dystonia (or spasmodic torticollis) is a neurological condition that results in abnormal movements and head posture, for which initial surgical intervention typically involves selective denervation of the sternocleidomastoid (SCM) and paraspinal muscles. However, muscle reactivation of the distal SCM stump can result in recurrent symptoms. In this study, the authors present their preliminary experience with distal SCM stump resection following selective denervation, with the aim of evaluating the effectiveness of the procedure and identifying patients who may benefit from this technique. This is a retrospective single-center cohort study of patients who underwent SCM stump resection as revision surgery for cervical dystonia. A total of 18 patients (10 males [56%]) were included with a median (range) age of 54 (40-70) years. All patients received selective denervation of the SCM at the authors' institution prior to SCM stump resection at a median (range) time of 12 (3-198) months between surgical procedures. At preoperative baseline, 13 patients (72%) possessed a rotational torticollis component to their head deviation, 12 (67%) possessed a laterocollis component, and 2 (11%) possessed a retrocollis component. At the most recent follow-up (median [range] 16 [4-119] months), 6 patients had complete resolution of their cervical dystonia (33%), while 10 had residual deviation (56%) and 2 had recurrent deviation (11%). However, compared to their post-selective denervation head position, 12 patients experienced improvement in their head position (67%), 4 patients had no change in their head position (22%), and 2 had worsening of their cervical dystonia (11%) following SCM stump resection. Importantly, 12 patients experienced improvement in their pain following SCM stump resection (67%). Patients who had a history of other movement/spasmodic disorders were more likely to have improvement in head position and improvement in pain after SCM stump resection, though neither of these results achieved statistical significance (p = 0.054). Additionally, patients who experienced full resolution of their cervical dystonia had shorter time between initial selective denervation surgery and SCM stump resection, though this result also did not achieve statistical significance (p = 0.068). Distal SCM stump resection following selective denervation is a simple, safe, and effective option for many patients in treating refractory cervical dystonia. Patients with more severe preoperative presentations may experience greater benefit from SCM stump resection, though additional investigations are needed.

Pain in dystonia is closely related neurological disorders, with significant impact on patients' quality of life. This study aims to conduct a bibliometric analysis to examine the development trends, research hotspots, and future directions in the field of pain in dystonia. Publications from 1981 to 2025 were retrieved from the Web of Science Core Collection database. Bibliometric data were analyzed using the R package "Bibliometrix," VOSviewer, and CiteSpace. A total of 1225 articles were included in this study. The USA had the highest publication volume (329), followed by Germany (103) and Italy (87). The most productive institution was the University of London with 123 publications. Movement Disorders was one of the most influential journals in its field. Key authors in the field included Jankovic Joseph, Marinus Johan, and Van Hilten Jacobus J. The high-frequency keywords were "double-blind," "efficacy," and "spasmodic torticollis." Keywords burst analysis showed emerging interests in "blepharospasm," "botulinum neurotoxin," "quality of life," "diagnosis," "management," and "neurotoxin." This bibliometric study quantitatively analyzed research trends in pain in dystonia, identifying key contributors, hotspots, and emerging trends. Keywords result reflected the growing interest in improving patient outcomes through better diagnostic techniques and therapeutic interventions aimed at alleviating symptoms and enhancing the quality of life for individuals affected by this condition.