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Treatments and drugs
By Mayo Clinic staffThere is no cure for cervical dystonia. In some people, signs and symptoms may disappear without treatment, but recurrence is common. 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, 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 (Cogentin), may be used in combination with botulinum toxin injections. Frequent side effects include dry mouth, constipation, memory problems, reduced urinary stream or visual blurring.
- Muscle relaxants. These drugs often help a little, but also have side effects, most notably sedation, imbalance and mild cognitive impairment. Examples include diazepam (Valium, Diastat), lorazepam (Ativan), clonazepam (Klonopin) and baclofen (Lioresal).
- Pain medications. The pain from cervical dystonia may require drug treatment. This may range from over-the-counter pain relievers to prescription pain medications.
Therapy
The signs and symptoms of cervical dystonia are sometimes eased by:
- Exercises that improve neck strength and flexibility
- Judicious use of a neck brace
- Training in stress management techniques
Surgical and other procedures
If less invasive treatments don't help, your doctor may suggest surgery.
- 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. This is called selective denervation surgery and isn't widely available.
- Deep brain stimulation (DBS). In this surgical procedure, 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 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. DBS is used only in the most difficult of cervical dystonia cases.
References
- Dystonias fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/dystonias/detail_dystonias.htm. Accessed Oct. 22, 2010.
- 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/223619158-5/1072359570/1678/124.html#4-u1.0-B978-1-4160-4007-1..50107-3_1714. Accessed Oct. 22, 2010.
- Comelia C. Classification and evaluation of dystonia. http://www.uptodate.com/home/index.html. Accessed Oct. 22, 2010.
- Singer C, et al. Cervical dystonia: Etiology and pathophysiology. Neurological Clinics. 2008;26(suppl 1):9.
- McNicoll L, et al. Dystonia. In: Ferri FF. Ferri's Clinical Advisor 2011. Philadelphia, Pa.: Mosby Elsevier; 2010. http://www.mdconsult.com/books/page.do?sid=1073503008&eid=4-u1.0-B978-0-323-05610-6..00013-5--s3170&isbn=978-0-323-05610-6&type=bookPage§ionEid=4-u1.0-B978-0-323-05610-6..00013-5--s3170&uniqId=223955816-3. Accessed Oct. 25, 2010.
- Neurological diagnostic tests and procedures. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/misc/diagnostic_tests.htm. Accessed Oct. 25, 2010.
- Comella C. Treatment of dystonia. http://www.uptodate.com/home/index.html. Accessed Oct. 25, 2010.
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