Affiliations: [a] Center for Pain Management, Loma Linda University School of Medicine, CA, USA | [b] Department of Physical Medicine and Rehabilitation, Loma Linda University School of Medicine, CA, USA | [c] University of Missouri-Kansas City School of Medicine, and Pain Consortium of Greater Kansas City, KY, USA
Correspondence:
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Correspondence to: Divakara Kedlaya, MBBS, Center for Pain Management, Loma Linda University School of Medicine, 11406 Loma Linda Drive, Loma Linda, CA 92354, USA. Tel.: +1 909 558 6211; Fax: +1 909 558 6278; E-mail: dayhand@pol.net.
Abstract: Cervical dystonia is the most common form of focal dystonia in adults. It is characterized by involuntary contraction of neck muscles, causing abnormal posture and movements of the head. Pain is present in about 75% patients. Botulinum toxin injection into the dystonic neck muscles is considered the treatment of choice for patients with cervical dystonia. Botulinum toxin binds presynaptically to cholinergic nerve terminals causing decreased release of acetyl choline and reduction in muscle tone. It is important to precisely identify the sites of pain and the muscles responsible for the abnormal posture to have better success. The incidence of complications can be reduced by the proper choice of dose for specific muscles. In this article, the authors review the clinical features, course, and pathophysiology of cervical dystonia. Also reviewed are the chemistry, pharmacology, mechanism of action of botulinum toxin along with practical aspects of its use and complications associated with its use in the treatment of cervical dystonia.
