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Cervical Dystonia

Department of Neurology and School of Medicine, Loma Linda University, Loma Linda, California, KDashtipour{at}llu.edu

Mandana Barahimi, MD

Department of Family Practice, Northridge Hospital Medical Center, Northridge, California

Samia Karkar, BS

School of Pharmacy, Loma Linda University, Loma Linda, California

Cervical dystonia, which is the most common form of focal dystonia, presents with sustained neck spasms, abnormal head posture, head tremor, and pain. One of the interesting and unique features of cervical dystonia is the geste antagoniste. There is not a well-described pathophysiology for cervical dystonia, but several hypotheses report involvement at the central and peripheral level. Treatment options include: oral medical therapy, botulinum toxin injection, and surgery. Oral medical therapy has limited efficacy in control of the symptoms of cervical dystonia. Two types of botulinum toxin, types A and B, are being used for treatment of cervical dystonia, with equivalent benefit. Surgery is an option when other treatments fail or become ineffective. The surgical procedures are brain lesioning, brain stimulation, and peripheral surgical intervention. Several trials are currently ongoing in the United States and Europe to evaluate the efficacy of deep brain surgery in cervical dystonia.

Key Words: Botulinum toxin • dystonia • torticollis

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