The management of cervical dystonia

Cervical dystonia (CD), also known as 'spasmodic torticollis', is the most common form of adult-onset focal dystonia. It is a chronic disorder for which there is no curative treatment. Proposed interventions only have a symptomatic effect that is directed at controlling the intensity of the dystonic contractions and their associated symptoms. Both serotypes of botulinum toxin (BtA and BtB) have shown efficacy for the treatment of CD, and they constitute the first-line therapy for CD. BtB constitutes the best medical treatment for secondary failures to BtA. The efficacy of all other proposed medications, including anticholinergics, should be considered unknown due to the lack of good-quality trials. This lack of evidence applies also to all physical rehabilitation treatments. Although the authors have concluded that all surgical procedures for CD should still be considered investigational, the best data supporting benefit of surgery comes from case series of selective peripheral denervation and pallidal deep brain stimulation.