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Cervical dystonia — SCE Neurology MCQ

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ModerateMovement DisordersCervical dystoniaSCE Neurology

A 49-year-old woman has painful involuntary turning of the head to the left with right sternocleidomastoid hypertrophy. Symptoms improve when she touches her chin. MRI cervical spine is unremarkable and there are no pyramidal signs. Oral trihexyphenidyl caused confusion. What is the most appropriate management?

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Correct answer: E — Botulinum toxin injections to involved muscles

Botulinum toxin injections to involved muscles is the best answer. Focal cervical dystonia is usually treated with targeted botulinum toxin injections, especially when oral anticholinergics are poorly tolerated. Opioids do not treat dystonia; levodopa is for dopa-responsive dystonia or Parkinson's; decompression is not indicated without structural compression; steroids are not routine. Clinical pearl: A sensory trick supports dystonia and can help identify the movement pattern.

Reference: NICE CKS dystonia; ABN botulinum toxin guidance