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Cervical Dystonia – Botulinum Toxin First-Line — SCE Neurology MCQ

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EasyMovement DisordersCervical Dystonia – Botulinum Toxin First-LineSCE Neurology

A 45-year-old woman with known MS has cervical dystonia (torticollis) — involuntary sustained rotation and tilting of her head to the right. This has been present for 6 months and is progressively worsening. She has no MS lesion at the basal ganglia. What is the first-line treatment for cervical dystonia regardless of underlying cause?

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Correct answer: B — Botulinum toxin injection to the overactive cervical muscles (sternocleidomastoid, splenius capitis, trapezius — guided by clinical assessment and EMG)

Botulinum toxin injection is the first-line treatment for cervical dystonia, providing relief in approximately 70–90% of patients for 3–4 months per cycle. Muscles selected for injection depend on the pattern of head posture (rotation, tilt, flexion, extension). EMG guidance improves targeting accuracy. NICE IPG76 supports botulinum toxin for cervical dystonia. A: Oral anticholinergics are second-line. C: Levodopa is for dopa-responsive dystonia (rare). D: DBS is for refractory generalised dystonia. E: Physiotherapy is adjunctive but insufficient alone.

Reference: NICE IPG76; ABN Dystonia Guidelines; BNF