Cervical dystonia: an update on therapeutics

ABSTRACT

Introduction: Cervical dystonia is the most common focal dystonia encountered in a movement disorders clinic. It may have a huge impact on patients’ quality of life due to involuntary movement and abnormal posture of the head, neck pain, limitations in the range of neck movements, and psycho-social stress. Botulinum toxin is the preferred treatment due to its efficacy and favorable safety profile. In addition to anticholinergics and muscle relaxants, deep brain stimulation and peripheral denervation surgeries are also available but should be considered only in otherwise refractory patients.

Areas covered: This article focuses on the current understanding and advances in the therapeutics for cervical dystonia. The authors have comprehensively reviewed the literature on various treatment options including physiotherapy, oral medications, botulinum toxin injections, and surgical interventions.

Expert opinion: Several treatment options are available for patients with cervical dystonia. In mild cases, physiotherapy and muscles relaxants may be satisfactory, but botulinum toxin remains the mainstay of treatment for most. Over the past three decades since the introduction of botulinum toxin for therapeutic use, there is a better understanding of the efficacy and safety of botulinum toxin formulations. Despite advances, there are knowledge gaps that need to be addressed in future studies.

KEYWORDS:

• Cervical dystonia
• botulinum toxin
• deep brain stimulation
• physical therapy
• peripheral denervation surgery

Article highlights

• Cervical dystonia is the most common dystonia seen in movement disorders clinics.

• Cervical dystonia has a significant impact on quality of life of the patients and adversely affects their activities of daily living due to involuntary movements and abnormal postures of the head and neck, neck pain, and psycho-social impact.

• Oral medications such as benzodiazepines, anticholinergics have a limited role in the treatment of cervical dystonia.

• Botulinum toxin is considered as the first-line treatment in patients with cervical dystonia.

• OnabotulinumtoxinA, IncobotulinumtoxinA, AbobotulinumtoxinA are type A botulinum toxins and RimabotulinumtoxinB is type B botulinum toxin; all have been approved by the US Food and Drug Administration for the treatment of cervical dystonia.

• Although electromyography, ultrasound, and other techniques are increasingly used in the administration of BoNT for the treatment of CD, there is no evidence that they meaningfully improve the clinical outcomes over the traditional palpation of the affected muscles, except in patients with obese necks or who may have involvement of deep cervical muscles.

• For patients who are refractory to medical therapies, deep brain stimulation and peripheral denervation can be offered as surgical options.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.