Adults with Cervical Dystonia

Overview Efficacy Safety Dosing

Characteristics

Cervical dystonia is the most common form of focal dystonia1

  • In 2007, cervical dystonia was estimated to affect more than 90,000 people in the United States1
  • Cervical dystonia is 1.3 to 2 times more common in women than in men1
  • Median age of onset is 41 years1

Types of head movement

  • Retrocollis, anterocollis, laterocollis, and rotational torticollis2
  • Torticollis and laterocollis, or a combination of these two, are the most common manifestations2
  • Head tremor2

Pathophysiology poorly understood1

  • Decreased motor inhibition may be involved1
  • Aberrant neuroplasticity (faulty sensorimotor map) may be also involved1

Etiology may be primary or secondary3

  • Primary form is the most prevalent3
  • The causes of secondary cervical dystonia include neurologic syndromes, trauma, tumors, hemorrhage, hypoxia, infection, and drug or chemical exposure3
Sensory tricks may provide partial, temporary relief1
Prognosis: stabilization of symptoms is common but can take several years4
  • Remission has been reported in 10% to 23% of patients4
  • However, progression to segmental dystonia occurs in up to 20% of patients4
Unlike other forms of focal dystonia, pain is often a prominent symptom1
Quality-of-life effects may be significant3
  • Abnormal postures can interfere with work and activities of daily living including driving, reading, and eating4
  • Symptoms worsen with stress, and the rates of depression and anxiety are high3
Misdiagnosis and underdiagnoses are common3,5
  • Misdiagnoses may include tremor, Parkinson’s disease, tics, chorea, psychogenic movement disorder, headache, and scoliosis5

References

  1. Dashtipour K, Lew M. Cervical dystonia. In: Stacy MA, ed. Handbook of Dystonia. 1st ed. New York, NY: Informa Healthcare; 2007:137-154.
  2. Tarsy D. Dystonia. In: Adler CH, Ahlskog JE, eds. Parkinson's Disease and Movement Disorders: Diagnosis and Treatment Guidelines for the Practicing Physician. Totowa, NJ: Humana Press; 2000:297-311.
  3. Dressler D. Clinical applications of botulinum toxin therapy. In: Dressler D, ed. Botulinum Toxin Therapy. Stuttgart, Germany: Georg Thleme; 2000:39-125.
  4. Jankovic J. Treatment of cervical dystonia. In: Brin MF, Cornella CL, Jnakovic J, eds. Dystonia: Etiology, Clinical Features, and Treatment. Philadelphia, PA: Lippincott Williams & Wilkins; 2004:159-166.
  5. Lalli S, Albanese A. The diagnostic challenge of primary dystonia: evidence from misdiagnosis. Mov Disord. 2010;25(11):1619-1626.