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Treatments and drugs
By Mayo Clinic staffThere is no cure for cervical dystonia. Treatment focuses on relieving the signs and symptoms.
Medications
People who have cervical dystonia often must use a combination of medications to reduce their signs and symptoms.
- Botulinum toxin. This paralyzing agent, often used to smooth facial wrinkles, comes in two varieties — type A (Botox) and type B (Myobloc) — that can be injected directly into the neck muscles affected by cervical dystonia. Most people with cervical dystonia see an immediate improvement with this treatment, which usually must be repeated every three to four months.
- Parkinson's drugs. Medications used to combat the tremors associated with Parkinson's disease, including trihexyphenidyl and benztropine, may be used in combination with botulinum toxin injections.
- Muscle relaxants. These types of drugs also reduce anxiety, so they are especially helpful with symptoms that are worsened by stress. Examples include diazepam (Valium), lorazepam (Ativan), clonazepam (Klonopin) and baclofen (Kemstro).
Therapy
Stretching and strengthening exercises to improve posture can help reduce pain and may prolong the effect of botulinum toxin injections.
Surgical and other procedures
If less invasive treatments don't help, your doctor may suggest surgery.
- Deep brain stimulation. This surgical procedure inserts a thin, insulated wire into the brain through a small hole cut into the skull. The tip of this electrode is placed in the portion of the brain that controls neck movement. The electrode is connected, via a wire that passes under the skin, to a small battery pack in your chest. The battery pack is about the size of a pocket watch, and it sends electrical pulses to the electrode to interrupt the nerve signals making your head twist.
- Cutting muscles or nerves. Surgery to cut the nerves or muscles responsible for the contorted posture associated with cervical dystonia can be performed to help those who no longer get benefit from botulinum toxin or medications.
- Dystonias fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/dystonias/dystonias.htm. Accessed Oct. 24, 2008.
- Bang MS, et al. Cervical dystonia. In: Frontera WR, et al. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2008. http://www.mdconsult.com/das/book/body/108327421-3/763666283/1678/124.html#4-u1.0-B978-1-4160-4007-1..50107-3_1714. Accessed Oct. 24, 2008.
- Stacy M. Epidemiology, clinical presentation and diagnosis of cervical dystonia. Neurological Clinics. 2008;26(suppl 1):23.
- Singer C, et al. Cervical dystonia: Etiology and pathophysiology. Neurological Clinics. 2008;26(suppl 1):9.
- Neurological diagnostic tests and procedures. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/misc/diagnostic_tests.htm. Accessed Oct. 29, 2008.
- Swope D, et al. Treatment recommendations and practical applications of botulinum toxin treatment of cervical dystonia. Neurological Clinics. 2008;26(suppl 1):54.
- Bajwa ZH. Botulinum toxins for dystonia, spasticity and chronic pain. http://www.uptodate.com/home/index.html. Accessed Oct. 30, 2008.
- Su M, et al. Anticholinergic poisoning. http://www.uptodate.com/home/index.html. Accessed Oct. 30, 2008.
- NINDS deep brain stimulation for Parkinson's disease information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/deep_brain_stimulation/deep_brain_stimulation.htm. Accessed Oct. 30, 2008.
